MEDICARE: MISS REBECCA PROVOST LAWSON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1538921721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS REBECCA PROVOST LAWSON PA

Provider Business Mailing Address
First Line	:	204 PARSONS RD
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-3348
Country	:	US
Telephone Number	:	854-201-3636
Fax Number	:	854-201-1983

Provider Business Practice Location Address
First Line	:	204 PARSONS RD
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-3348
Country	:	US
Telephone Number	:	854-201-3636
Fax Number	:	854-201-1983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	01/21/2026

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