Healthcare Provider Details

I. General information

NPI: 1356262372
Provider Name (Legal Business Name): MACEE ROBERTSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 OKATIE CENTER BLVD S
OKATIE SC
29909-7507
US

IV. Provider business mailing address

96 SALUDA WAY
BEAUFORT SC
29906-6007
US

V. Phone/Fax

Practice location:
  • Phone: 843-379-7746
  • Fax:
Mailing address:
  • Phone: 865-640-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA6499
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: