Provider Demographics
NPI:1265490643
Name:KELLOGG, WILLIAM SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:KELLOGG
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:PO BOX 1244
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-1244
Mailing Address - Country:US
Mailing Address - Phone:803-934-8833
Mailing Address - Fax:803-934-0787
Practice Address - Street 1:1105 N LAFAYETTE DR
Practice Address - Street 2:SUITE A
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2913
Practice Address - Country:US
Practice Address - Phone:803-934-8833
Practice Address - Fax:803-934-0787
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17231207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-1111938OtherTAX ID
SCG2590566528OtherMEDICARE ID-TYPE UNSPECIFIED
SC172315Medicaid
SCG25905Medicare UPIN
GA582586550OtherTAX ID