Healthcare Provider Details

I. General information

NPI: 1518522077
Provider Name (Legal Business Name): SARAH PARTIN JOHN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH PARTIN

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RICHLAND MEDICAL PARK DR STE 450
COLUMBIA SC
29203-6859
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-8002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3212
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3212
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: