Provider Demographics
NPI:1982733432
Name:SCDDSN
Entity Type:Organization
Organization Name:SCDDSN
Other - Org Name:WHITTEN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:GATCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-938-3335
Mailing Address - Street 1:28373 HWY. 76 E
Mailing Address - Street 2:P.O. BOX 239
Mailing Address - City:CLIINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325
Mailing Address - Country:US
Mailing Address - Phone:864-833-2733
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB92041Medicare UPIN