Provider Demographics
NPI:1932199684
Name:DICKENS-CARR, KENDREIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDREIA
Middle Name:
Last Name:DICKENS-CARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KENDREIA
Other - Middle Name:WYNETTE
Other - Last Name:DICKENS-WILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK RD STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6839
Practice Address - Country:US
Practice Address - Phone:803-434-4480
Practice Address - Fax:803-434-3340
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11104207V00000X
SC88936207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology