Healthcare Provider Details

I. General information

NPI: 1124184155
Provider Name (Legal Business Name): JULIE ANN WEST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W LIBERTY ST
SUMTER SC
29150-5139
US

IV. Provider business mailing address

810 WESTFIELD CT
SUMTER SC
29154-9186
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-7000
  • Fax: 803-774-7004
Mailing address:
  • Phone: 803-494-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number970
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: