MEDICARE: KEVIN OLIVER LOKUWADUGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5637	SC
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1043937014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN OLIVER LOKUWADUGE

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE STE 300
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2899
Country	:	US
Telephone Number	:	864-522-8611
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 JOHN ST STE 201
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-1406
Country	:	US
Telephone Number	:	864-522-4630
Fax Number	:	864-522-4635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	01/26/2026

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