Healthcare Provider Details

I. General information

NPI: 1003302936
Provider Name (Legal Business Name): ALEXANDRA LYLE RATELIFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HIGHWAY 17 N
SURFSIDE BEACH SC
29575-6015
US

IV. Provider business mailing address

4607 PINE LAKE DR
MYRTLE BEACH SC
29577-2640
US

V. Phone/Fax

Practice location:
  • Phone: 843-238-1461
  • Fax:
Mailing address:
  • Phone: 843-995-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: