Healthcare Provider Details

I. General information

NPI: 1942852157
Provider Name (Legal Business Name): ANNA GAYLE SCOTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3574 SUNSET BLVD
WEST COLUMBIA SC
29169-3044
US

IV. Provider business mailing address

3574 SUNSET BLVD
WEST COLUMBIA SC
29169-3044
US

V. Phone/Fax

Practice location:
  • Phone: 37-962-5008
  • Fax: 803-796-4378
Mailing address:
  • Phone: 803-796-2500
  • Fax: 803-796-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2519
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: