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General NPI Number Information
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NPI Number | 1255210399
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Entity Type | Individual
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Provider Name | JUSTIN SUAREZ PA
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Gender | Male
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 106 GREGOR MENDEL CIR
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City | GREENWOOD
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State | SC
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Zip | 29646-2315
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Country | US
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Telephone | 810-094-1864
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Fax |
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Provider Business Mailing Address
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Address Line | 500 CONGAREE RD APT 7107
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City | GREENVILLE
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State | SC
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Zip | 29607-4767
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Country | US
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Telephone | 954-881-8679
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6005
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License Number State | SC
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