MEDICARE: MRS. COURTNEY MARIE CASEY 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	15-01690	KS
2	363A00000X	Physician Assistant	2432	OK
3	363A00000X	Physician Assistant	TL2715	SC

General Provider Information

NPI Number	:	1508285685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY MARIE CASEY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 741327
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-1327
Country	:	US
Telephone Number	:	803-396-8100
Fax Number	:	803-396-8040

Provider Business Practice Location Address
First Line	:	502 SIXTH BAXTER XING
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6596
Country	:	US
Telephone Number	:	803-396-8100
Fax Number	:	803-396-8040

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	05/03/2017

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