Individual
MR. KEVIN WALTER BURNHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
24 E MAIN ST, WILLIAMSTON, SC 29697-1925
(864) 847-6020
Mailing address
24 E MAIN ST, WILLIAMSTON, SC 29697-1925
(864) 847-6020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
SC 1049FP
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SC 1049FP
MEDICAL PRACTICE/RX
SC
Enumeration date
09/20/2006
Last updated
11/02/2011
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