MEDICARE: DR. JUSTIN KELBY HUTCHESON MD MS

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	23320	SC
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	057825	GA
3	208VP0014X	Interventional Pain Medicine Physician	23320	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154421915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN KELBY HUTCHESON MD MS

Provider Business Mailing Address
First Line	:	PO BOX 6130
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29304-6130
Country	:	US
Telephone Number	:	864-583-2337
Fax Number	:	864-583-0147

Provider Business Practice Location Address
First Line	:	10 ENTERPRISE BLVD STE 201
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3554
Country	:	US
Telephone Number	:	864-583-2337
Fax Number	:	864-583-0147

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	02/15/2021

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