Provider Demographics
NPI:1730159047
Name:KREBS, KEVIN W (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:W
Last Name:KREBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 ATRIUM WAY
Mailing Address - Street 2:SUITE 127
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6371
Mailing Address - Country:US
Mailing Address - Phone:803-699-4899
Mailing Address - Fax:803-699-4407
Practice Address - Street 1:115 ATRIUM WAY
Practice Address - Street 2:SUITE 127
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6371
Practice Address - Country:US
Practice Address - Phone:803-699-4899
Practice Address - Fax:803-699-4407
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC167572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC123-45-6789OtherBEHAVIORAL HEALTH
SC167571Medicaid
SC167571Medicaid
SCF619680281Medicare ID - Type Unspecified