Healthcare Provider Details

I. General information

NPI: 1730900317
Provider Name (Legal Business Name): ERYN MARIE TIMMONS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 EPTING AVE
GREENWOOD SC
29646-4041
US

IV. Provider business mailing address

421 EPTING AVE
GREENWOOD SC
29646-4041
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-6818
  • Fax:
Mailing address:
  • Phone: 864-477-8582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5580
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: