MEDICARE: COURTNEY HILL KALLINGER PA-C

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	2901	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SCD1575019	OTHER	SC	MEDICARE PIN

General Provider Information

NPI Number	:	1386134682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY HILL KALLINGER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 743070
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 BOILING SPRINGS RD STE 1700
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4208
Country	:	US
Telephone Number	:	864-560-6844
Fax Number	:

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

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	12/10/2019

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