Healthcare Provider Details

I. General information

NPI: 1932974706
Provider Name (Legal Business Name): MCLEAN MARIE ACHZIGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N SUMTER ST STE 300
SUMTER SC
29150-4967
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-775-1550
  • Fax: 803-775-7258
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5193
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: