Healthcare Provider Details

I. General information

NPI: 1629616768
Provider Name (Legal Business Name): DALE ANDREWS JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 SPRING ST
GREENWOOD SC
29646-4071
US

IV. Provider business mailing address

1325 SPRING ST
GREENWOOD SC
29646-3875
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-7900
  • Fax: 864-725-7910
Mailing address:
  • Phone: 864-725-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027289
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5977
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: