Healthcare Provider Details

I. General information

NPI: 1396586889
Provider Name (Legal Business Name): KAITLYN SHILLINGLAW DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SPRING ST
GREENWOOD SC
29646-3860
US

IV. Provider business mailing address

104 WELLS AVE
GREENWOOD SC
29646-3837
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-4780
  • Fax:
Mailing address:
  • Phone: 864-725-4865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number91470
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: