Healthcare Provider Details

I. General information

NPI: 1780115907
Provider Name (Legal Business Name): ERIN FITZPATRICK KALLAM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR STE A300
GREENVILLE SC
29615-6303
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-5530
  • Fax: 864-241-9246
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number86633
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number87923
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: