Individual
KERISEA SAMATA MCPHERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 SAINT FRANCIS DR, GREENVILLE, SC 29601-3955
(864) 255-1057
Mailing address
P O BOX 634706, CINCINNATI, OH 45263-4706
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25098
SC
208M00000X
Hospitalist Physician
Primary
25098
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250980
—
SC
01
—
P00317364
RAILROAD MEDICARE
SC
Enumeration date
05/28/2006
Last updated
12/03/2007
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