Provider Demographics
NPI:1336314418
Name:KAVANAGH, JULIE SPELLMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:SPELLMAN
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:8311 WARREN H ABERNATHY HWY
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1249
Practice Address - Country:US
Practice Address - Phone:864-562-5400
Practice Address - Fax:864-562-5431
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC13246208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC132467Medicaid