Healthcare Provider Details

I. General information

NPI: 1063079564
Provider Name (Legal Business Name): KELSEY SPEARMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VINECREST CT # 600
GREENWOOD SC
29646-8031
US

IV. Provider business mailing address

105 VINECREST CT # 600
GREENWOOD SC
29646-8031
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-2900
  • Fax: 864-227-6487
Mailing address:
  • Phone: 864-227-2900
  • Fax: 864-227-6487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82498
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: