Individual
KIM C TERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
526 NORTH ST, BAMBERG, SC 29003-1319
(803) 245-2433
(803) 245-6274
Mailing address
86 WREN ST, BARNWELL, SC 29812-1529
(803) 259-5762
(803) 259-3250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1153
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1096PA
—
SC
01
—
1153
MEDICAL LICENSE
SC
Enumeration date
01/29/2007
Last updated
06/30/2021
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