Provider Demographics
NPI:1538419429
Name:TUITT, KELENNE V (DO)
Entity type:Individual
Prefix:DR
First Name:KELENNE
Middle Name:V
Last Name:TUITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1245
Mailing Address - Country:US
Mailing Address - Phone:803-395-4497
Mailing Address - Fax:803-395-2237
Practice Address - Street 1:498 NORTH ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1377
Practice Address - Country:US
Practice Address - Phone:803-395-4497
Practice Address - Fax:803-395-2237
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJTRAINING PERMIT207Q00000X
SC36741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5677Medicare PIN