Provider Demographics
NPI:1326164328
Name:GATCHELL, KEITH CALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:CALVIN
Last Name:GATCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MILAM RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-6318
Mailing Address - Country:US
Mailing Address - Phone:864-938-3335
Mailing Address - Fax:864-938-3393
Practice Address - Street 1:28373 HWY.76 EAST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325
Practice Address - Country:US
Practice Address - Phone:864-833-2733
Practice Address - Fax:864-938-3393
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC08799385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child