Healthcare Provider Details

I. General information

NPI: 1174695316
Provider Name (Legal Business Name): REBECCA ZERWICK JOHNSON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNNE ZERWICK PA

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 MIDLAND PKWY
SUMMERVILLE SC
29485-8104
US

IV. Provider business mailing address

1946 OAK TREE LN
MOUNT PLEASANT SC
29464-9413
US

V. Phone/Fax

Practice location:
  • Phone: 843-832-5000
  • Fax:
Mailing address:
  • Phone: 843-906-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1146
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: