Healthcare Provider Details

I. General information

NPI: 1730628629
Provider Name (Legal Business Name): ELIZABETH MCLAWHORN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 JOHNS HOPKINS DRIVE
GREENVILLE NC
27835
US

IV. Provider business mailing address

850 JOHNS HOPKINS DRIVE
GREENVILLE NC
27835
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-5227
  • Fax:
Mailing address:
  • Phone: 252-752-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-07052
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: