Provider Demographics
NPI:1942409651
Name:HERRING, KATRINA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:HERRING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 STOCKBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7200
Mailing Address - Country:US
Mailing Address - Phone:803-547-5447
Mailing Address - Fax:803-396-0095
Practice Address - Street 1:773 STOCKBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7200
Practice Address - Country:US
Practice Address - Phone:803-547-5447
Practice Address - Fax:803-396-0095
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL30086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC300864Medicaid
AA5860Medicare UPIN
SCAA58609106Medicare PIN