Healthcare Provider Details

I. General information

NPI: 1215630215
Provider Name (Legal Business Name): CAROLINA PHYSICIANS AND REHAB, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
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 26838
GREENVILLE SC
29616-1838
US

V. Phone/Fax

Practice location:
  • Phone: 888-699-4188
  • Fax: 864-335-9252
Mailing address:
  • Phone: 888-699-4188
  • Fax: 864-335-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN KELBY HUTCHESON
Title or Position: OWNER
Credential: MD
Phone: 888-699-4188