Individual
DAVID KIRK DEPRIEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
135 COMMONWEALTH DR., STE. 210, GREENVILLE, SC 29615-4815
(864) 675-4815
(864) 675-4780
Mailing address
PO BOX 743294, ATLANTA, GA 30374-3294
(864) 675-4815
(864) 675-4780
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4145
OK
208600000X
Surgery Physician
792
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007922
—
SC
05
—
200025290A
—
OK
01
—
200025290B
MEDICAID OSU AJ
OK
01
—
P01319268
RAILROAD
OK
01
—
SC85217628
MEDICARE PIN
SC
Enumeration date
07/20/2005
Last updated
12/01/2021
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