Individual
KELLEY BANAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
96 JONATHAN LUCAS STREET CSB 708 MSC 622, CHARLESTON, SC 29425-1544
(843) 792-8105
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
D72819
MD
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
MD93962
SC
Other
Enumeration date
02/16/2007
Last updated
04/10/2025
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