Healthcare Provider Details

I. General information

NPI: 1548882129
Provider Name (Legal Business Name): AUSTIN JACOB KAISER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PHYSICIANS DR STE B
GREER SC
29650-2446
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-8647
  • Fax: 864-797-9175
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number84118
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: