Provider Demographics
NPI:1053871921
Name:CARMICHAEL, KRYSTAL KAYLA (MD)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:KAYLA
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-3595
Mailing Address - Fax:
Practice Address - Street 1:986 WELLNESS WAY STE 350
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7354
Practice Address - Country:US
Practice Address - Phone:803-396-0661
Practice Address - Fax:803-396-0015
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC90725207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program