Provider Demographics
NPI:1508285685
Name:CASEY, COURTNEY MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MARIE
Last Name:CASEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MARIE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 741327
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1327
Mailing Address - Country:US
Mailing Address - Phone:803-396-8100
Mailing Address - Fax:803-396-8040
Practice Address - Street 1:502 SIXTH BAXTER XING
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6596
Practice Address - Country:US
Practice Address - Phone:803-396-8100
Practice Address - Fax:803-396-8040
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01690363A00000X
OK2432363A00000X
SCTL2715363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant