Provider Demographics
NPI:1821126236
Name:HUGGINS, PHILLIP KENNETH SR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:KENNETH
Last Name:HUGGINS
Suffix:SR
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:PALMETTO HEALTH
Mailing Address - Street 2:1321 LADY STREET, FIRST FLOOR
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-296-5797
Mailing Address - Fax:803-296-5023
Practice Address - Street 1:PALMETTO HEALTH
Practice Address - Street 2:1321 LADY STREET, FIRST FLOOR
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-296-5797
Practice Address - Fax:803-296-5023
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4099282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC400863Medicaid
SC400863Medicaid