Provider Demographics
NPI:1770533523
Name:KERLEY, ERIC L (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:KERLEY
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 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:
Practice Address - Street 1:1056 FELTON ST
Practice Address - Street 2:
Practice Address - City:SUMMERTON
Practice Address - State:SC
Practice Address - Zip Code:29148-7169
Practice Address - Country:US
Practice Address - Phone:803-488-4800
Practice Address - Fax:803-488-4801
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39291207R00000X, 208000000X
NY293258207R00000X
SC34416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3332441Medicaid
SC344167Medicaid
TN3332441Medicare ID - Type Unspecified