Healthcare Provider Details

I. General information

NPI: 1881846947
Provider Name (Legal Business Name): CAROL SUE EATON MPA, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 BELL ST
CONWAY SC
29526-4113
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTENTION PATIENT ACCOUNTING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-488-2111
  • Fax: 843-448-2112
Mailing address:
  • Phone: 843-234-6946
  • Fax: 843-234-8958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2312
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005454
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: