Healthcare Provider Details

I. General information

NPI: 1437923075
Provider Name (Legal Business Name): SAVANNAH HALTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 TRICOM ST
NORTH CHARLESTON SC
29406-9192
US

IV. Provider business mailing address

2850 TRICOM ST
NORTH CHARLESTON SC
29406-9192
US

V. Phone/Fax

Practice location:
  • Phone: 843-863-1188
  • Fax: 843-863-8286
Mailing address:
  • Phone: 843-863-1188
  • Fax: 843-863-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5087
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5087
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: