Individual
KATHY BOLUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
650 ELLIS OAK DR, CHARLESTON, SC 29412-3090
(843) 762-5480
(843) 762-5488
Mailing address
PO BOX 751357, CHARLOTTE, NC 28275-1357
(843) 762-5480
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15226
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152266
—
SC
Enumeration date
03/10/2006
Last updated
03/05/2008
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