Individual
KEVIN MICHAEL DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
853 N CHURCH ST STE 620, SPARTANBURG, SC 29303-3070
(864) 573-7511
(864) 560-1690
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
39648
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
396486
—
SC
01
—
SCH6525206
MEDICARE PIN
SC
Enumeration date
06/06/2016
Last updated
08/15/2024
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