Provider Demographics
NPI:1235248824
Name:HANLIN, ROBERT JOSEPH (PAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:HANLIN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W ALEXANDER AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4078
Mailing Address - Country:US
Mailing Address - Phone:864-725-7900
Mailing Address - Fax:864-725-7910
Practice Address - Street 1:303 W ALEXANDER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4078
Practice Address - Country:US
Practice Address - Phone:864-725-7900
Practice Address - Fax:864-725-7910
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310363A00000X
SC1881363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42915800Medicaid
SC1609PAMedicaid
WI052372200Medicare ID - Type Unspecified
R97829Medicare UPIN
WI42915800Medicaid