Provider Demographics
NPI:1154421915
Name:HUTCHESON, JUSTIN KELBY (MD MS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:KELBY
Last Name:HUTCHESON
Suffix:
Gender:M
Credentials:MD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6130
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-6130
Mailing Address - Country:US
Mailing Address - Phone:864-583-2337
Mailing Address - Fax:864-583-0147
Practice Address - Street 1:10 ENTERPRISE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3554
Practice Address - Country:US
Practice Address - Phone:864-583-2337
Practice Address - Fax:864-583-0147
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23320207LP2900X, 208VP0014X
GA057825207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC233205Medicaid
SCAA09015640Medicare PIN
SCAA09016655Medicare PIN
SCAA0901Medicare ID - Type Unspecified
SC233205Medicaid