Healthcare Provider Details

I. General information

NPI: 1457915001
Provider Name (Legal Business Name): HANNAH REBEKAH MAYHAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FOREST DR STE A
COLUMBIA SC
29206-3105
US

IV. Provider business mailing address

4500 FOREST DR
COLUMBIA SC
29206-3105
US

V. Phone/Fax

Practice location:
  • Phone: 803-738-9522
  • Fax:
Mailing address:
  • Phone: 770-584-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3798
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: