Provider Demographics
NPI:1659497238
Name:KITCHENS, WILLIAM CLAUDE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLAUDE
Last Name:KITCHENS
Suffix:JR
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 1:124 TALL PINES TRL
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-9276
Mailing Address - Country:US
Mailing Address - Phone:864-229-0436
Mailing Address - Fax:
Practice Address - Street 1:124 TALL PINES TRL
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-9276
Practice Address - Country:US
Practice Address - Phone:864-229-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC69532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC069534Medicaid
SC069534Medicaid