Provider Demographics
NPI:1669565768
Name:HUNT, CHANDLER GORE (PA C)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:GORE
Last Name:HUNT
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8676
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604-8676
Mailing Address - Country:US
Mailing Address - Phone:864-232-7338
Mailing Address - Fax:
Practice Address - Street 1:125 HALTON RD STE 200
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3507
Practice Address - Country:US
Practice Address - Phone:864-232-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA922363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3968Medicare ID - Type Unspecified
Q21730Medicare UPIN