Provider Demographics
NPI:1437244142
Name:HUTCHINSON, KYLLAN JOHNSON (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLLAN
Middle Name:JOHNSON
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 ADAMS GRV
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6951
Mailing Address - Country:US
Mailing Address - Phone:803-256-0531
Mailing Address - Fax:
Practice Address - Street 1:2113 ADAMS GRV
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6951
Practice Address - Country:US
Practice Address - Phone:803-256-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics