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General NPI Number Information
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NPI Number | 1790838621
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Entity Type | Individual
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Provider Name | KELLY G SVEDBERG PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 2424 INDIA HOOK RD STE 120
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City | ROCK HILL
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State | SC
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Zip | 29732-1278
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Country | US
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Telephone | 704-350-5885
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Fax | 936-244-4599
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Provider Business Mailing Address
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Address Line | 7819 JAARS RD
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City | WAXHAW
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State | NC
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Zip | 28173-7677
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Country | US
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Telephone | 704-350-5885
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Fax | 936-244-4599
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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 | PA10819
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License Number State | TX
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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 | 0010-00631
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License Number State | NC
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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 | PA1575
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License Number State | SC
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