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Individual

MRS. KATHLEEN MCCOMBS MITCHELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
701 CONGAREE RD, GREENVILLE, SC 29607-3519
(864) 458-7289
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2277
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2162PA
SC
01
SC56835019
MEDICARE PIN
SC
01
SC56836067
MEDICARE PIN
SC
01
SC56836084
MEDICARE PIN
SC
01
SC5683J577
MEDICARE PIN
SC
Enumeration date
04/27/2015
Last updated
07/03/2024
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