Healthcare Provider Details

I. General information

NPI: 1225017502
Provider Name (Legal Business Name): LIKA J SCHROCK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 11/03/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 RIBAUT RD
PORT ROYAL SC
29935-1403
US

IV. Provider business mailing address

PO BOX 749306
ATLANTA GA
30374-9306
US

V. Phone/Fax

Practice location:
  • Phone: 843-770-0676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number633
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: