Organization
KINGSTREE FAMILY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND KEELS ALLEN MD (PRESIDENT)
(843) 355-5459
Entity
Organization
Contact information
Practice address
512 NELSON BLVD, SUITE 200, KINGSTREE, SC 29556-4027
(843) 355-5459
(843) 355-9704
Mailing address
512 NELSON BLVD, SUITE 200, KINGSTREE, SC 29556-4027
(843) 355-5459
(843) 355-9704
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11529
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0509
—
SC
Enumeration date
09/22/2005
Last updated
06/03/2008
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