Provider Demographics
NPI:1609880715
Name:CARSON, KEVIN WRIGHT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WRIGHT
Last Name:CARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3808
Mailing Address - Country:US
Mailing Address - Phone:864-223-8090
Mailing Address - Fax:864-223-4026
Practice Address - Street 1:160 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3808
Practice Address - Country:US
Practice Address - Phone:864-223-8090
Practice Address - Fax:864-223-4026
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18545208600000X
GA049879208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9337OtherGROUP MEDICARE
SCGP5280OtherGROUP MEDICAID
SC185454Medicaid
LA1460567Medicaid
H47294Medicare UPIN
SC185454Medicaid