Healthcare Provider Details

I. General information

NPI: 1477111615
Provider Name (Legal Business Name): PAIGE ALYSE WEAVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 N FRASER ST
GEORGETOWN SC
29440-2848
US

IV. Provider business mailing address

PO BOX 421718
GEORGETOWN SC
29442-4203
US

V. Phone/Fax

Practice location:
  • Phone: 843-527-4442
  • Fax: 843-527-4027
Mailing address:
  • Phone: 843-527-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3293
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: