Healthcare Provider Details

I. General information

NPI: 1578348017
Provider Name (Legal Business Name): ANNALEIGH AUTRY HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E GREENVILLE ST
ANDERSON SC
29621-2004
US

IV. Provider business mailing address

2717 E OAKLAND AVE
JOHNSON CITY TN
37601-1843
US

V. Phone/Fax

Practice location:
  • Phone: 864-226-8356
  • Fax:
Mailing address:
  • Phone: 423-926-2358
  • Fax: 423-926-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6382
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: