Individual
DR. KELLY HEEGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
203 MILLS AVE, GREENVILLE, SC 29605-4019
(864) 271-1844
(864) 271-2147
Mailing address
203 MILLS AVE, GREENVILLE, SC 29605-4019
(864) 271-1844
(864) 271-2147
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
52383
SC
207RN0300X
Nephrology Physician
ME131121
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52383
SC MEDICAL LICENSE
SC
05
—
523838
—
SC
Enumeration date
06/25/2009
Last updated
04/30/2019
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