Healthcare Provider Details

I. General information

NPI: 1083310650
Provider Name (Legal Business Name): CAROLINE HUFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CALLEN BLVD
SUMMERVILLE SC
29486-2807
US

IV. Provider business mailing address

1328 1ST AVE NW
HICKORY NC
28601-5923
US

V. Phone/Fax

Practice location:
  • Phone: 854-529-3100
  • Fax:
Mailing address:
  • Phone: 828-320-3523
  • 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: