MEDICARE: KELLY G SVEDBERG PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA10819	TX
2	363A00000X	Physician Assistant	0010-00631	NC
3	363A00000X	Physician Assistant	PA1575	SC

General Provider Information

NPI Number	:	1790838621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY G SVEDBERG PA-C

Provider Business Mailing Address
First Line	:	7819 JAARS RD
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-7677
Country	:	US
Telephone Number	:	704-350-5885
Fax Number	:	936-244-4599

Provider Business Practice Location Address
First Line	:	2424 INDIA HOOK RD STE 120
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1278
Country	:	US
Telephone Number	:	704-350-5885
Fax Number	:	936-244-4599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	12/20/2024

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