Healthcare Provider Details

I. General information

NPI: 1154421915
Provider Name (Legal Business Name): JUSTIN KELBY HUTCHESON MD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ENTERPRISE BLVD STE 201
GREENVILLE SC
29615-3554
US

IV. Provider business mailing address

PO BOX 6130
SPARTANBURG SC
29304-6130
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-2337
  • Fax: 864-583-0147
Mailing address:
  • Phone: 864-583-2337
  • Fax: 864-583-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number23320
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number057825
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number23320
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: