Healthcare Provider Details

I. General information

NPI: 1528601762
Provider Name (Legal Business Name): BAILEY MADISON FITCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BAILEY MADISON HOLBROOK PA-C

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9313 MEDICAL PLAZA DR STE 202
CHARLESTON SC
29406-9176
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3599
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: