Healthcare Provider Details

I. General information

NPI: 1952147498
Provider Name (Legal Business Name): KETAMINE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 MILESTONE WAY STE A
GREENVILLE SC
29615-6618
US

IV. Provider business mailing address

3523 PELHAM RD STE C
GREENVILLE SC
29615-4191
US

V. Phone/Fax

Practice location:
  • Phone: 864-236-1630
  • Fax:
Mailing address:
  • Phone: 864-527-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOY BAILLEY
Title or Position: MEMBER
Credential:
Phone: 864-527-1250