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General NPI Number Information
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NPI Number | 1962503516
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Entity Type | Individual
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Provider Name | DONALD WAYNE VANN PA
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 109 BEE ST
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City | CHARLESTON
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State | SC
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Zip | 29401-5703
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Country | US
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Telephone | 843-577-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 4929 HIDEAWAY POINTE
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City | HOLLYWOOD
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State | SC
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Zip | 29449
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Country | US
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Telephone | 843-573-9020
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1009290
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License Number State | SC
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