Healthcare Provider Details

I. General information

NPI: 1255107561
Provider Name (Legal Business Name): SAVANNAH ROSE STYLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PLAZA CIR
CLINTON SC
29325-7557
US

IV. Provider business mailing address

509 MCKITTRICK BRIDGE RD
FOUNTAIN INN SC
29644-9797
US

V. Phone/Fax

Practice location:
  • Phone: 864-938-9690
  • Fax:
Mailing address:
  • Phone: 615-390-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5117
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5117
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: