Individual
IRAKLI KHULORDAVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
819 N FANT ST, ANDERSON, SC 29621-5717
(864) 261-1800
(864) 261-1856
Mailing address
819 N FANT ST, ANDERSON, SC 29621-5717
(864) 261-1800
(864) 261-1856
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29322
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293220
—
SC
01
—
P00137642
RR MEDICARE
SC
Enumeration date
10/20/2006
Last updated
02/07/2019
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