Provider Demographics
NPI:1881752780
Name:KANDLE, JUSTIN RHEA (PA-C)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:RHEA
Last Name:KANDLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:295A MIDLAND PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5901
Mailing Address - Country:US
Mailing Address - Phone:843-875-8994
Mailing Address - Fax:843-875-8981
Practice Address - Street 1:295A MIDLAND PKWY STE 260
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5901
Practice Address - Country:US
Practice Address - Phone:843-875-8994
Practice Address - Fax:843-875-8981
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5916363A00000X
NC0010-13979363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant