Healthcare Provider Details

I. General information

NPI: 1447172515
Provider Name (Legal Business Name): REBECCA LEE PETTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W WADE HAMPTON BLVD STE 9A
GREER SC
29650-1297
US

IV. Provider business mailing address

955 W WADE HAMPTON BLVD STE 9A
GREER SC
29650-1297
US

V. Phone/Fax

Practice location:
  • Phone: 336-505-9714
  • Fax:
Mailing address:
  • Phone: 336-505-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: