Healthcare Provider Details

I. General information

NPI: 1184416190
Provider Name (Legal Business Name): REBECCA MCCLAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 W SANDHURST DR
FLORENCE SC
29505-2988
US

IV. Provider business mailing address

2015 W SANDHURST DR
FLORENCE SC
29505-2988
US

V. Phone/Fax

Practice location:
  • Phone: 843-319-4943
  • Fax: 843-319-4943
Mailing address:
  • Phone: 843-319-4943
  • Fax: 843-319-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30125
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: