Individual
WALTER R KIRBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
333 REVOLUTIONARY TRL, FAIRFAX, SC 29827-7109
(803) 632-2533
(803) 632-2451
Mailing address
86 WREN ST, BARNWELL, SC 29812-1529
(803) 259-5762
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2214
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2119PA
—
SC
01
—
2214
MEDICAL LICENSE
SC
Enumeration date
04/29/2009
Last updated
01/11/2024
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