Healthcare Provider Details

I. General information

NPI: 1083107429
Provider Name (Legal Business Name): ELEASA MARIE HULON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

701 GROVE RD
GREENVILLE SC
29605-4210
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7882
  • Fax:
Mailing address:
  • Phone: 864-455-7882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDR.0069837
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberDR.0069837
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberDR.0069837
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number125073446
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: