Healthcare Provider Details

I. General information

NPI: 1538921721
Provider Name (Legal Business Name): REBECCA PROVOST LAWSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 PARSONS RD
SUMMERVILLE SC
29483-3348
US

IV. Provider business mailing address

204 PARSONS RD
SUMMERVILLE SC
29483-3348
US

V. Phone/Fax

Practice location:
  • Phone: 854-201-3636
  • Fax: 854-201-1983
Mailing address:
  • Phone: 854-201-3636
  • Fax: 854-201-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: