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General NPI Number Information
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NPI Number | 1518381482
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Entity Type | Individual
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Provider Name | ELIZABETH KELLAM P.A.
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Gender | Female
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 853 N CHURCH ST SUITE 720C
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City | SPARTANBURG
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State | SC
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Zip | 29303-3098
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Country | US
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Telephone | 864-560-6419
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Fax | 864-560-7498
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Provider Business Mailing Address
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Address Line | PO BOX 743070
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City | ATLANTA
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State | GA
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Zip | 30374-3070
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Country | US
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Telephone | 864-560-4304
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Fax | 864-560-4413
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0005328
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TL2484
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2484
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License Number State | SC
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