Provider Demographics
NPI:1265408967
Name:DAVIS-SEAGLE, KIMBERLY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LYNN
Last Name:DAVIS-SEAGLE
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 1:498 WANDO PARK BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7963
Mailing Address - Country:US
Mailing Address - Phone:843-216-8160
Mailing Address - Fax:866-834-5680
Practice Address - Street 1:498 WANDO PARK BLVD STE 500
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7963
Practice Address - Country:US
Practice Address - Phone:843-216-8160
Practice Address - Fax:866-834-5680
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110236858OtherRR MEDICARE
SC165635Medicaid
SC165635Medicaid