MEDICARE: CAROLINE CALDER GREEN PA

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	4895	SC
2	363AS0400X	Surgical Physician Assistant	4895	SC

General Provider Information

NPI Number	:	1679269823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE CALDER GREEN PA

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-695-6697
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 N SUMTER ST STE 300
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-4967
Country	:	US
Telephone Number	:	803-774-1550
Fax Number	:	803-775-7258

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

Provider Enumeration Date	:	04/12/2023
Last Update Date	:	12/09/2025

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Directions to “ CAROLINE CALDER GREEN PA” Practice Location

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