Healthcare Provider Details

I. General information

NPI: 1235248824
Provider Name (Legal Business Name): ROBERT JOSEPH HANLIN PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W ALEXANDER AVE SUITE E
GREENWOOD SC
29646-4078
US

IV. Provider business mailing address

303 W ALEXANDER AVE SUITE E
GREENWOOD SC
29646-4078
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-7900
  • Fax: 864-725-7910
Mailing address:
  • Phone: 864-725-7900
  • Fax: 864-725-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number310
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1881
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: