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NPI Code Detail

MEDICARE: SAVANNAH FAYE WAWNER PA-C

MEDICARE: SAVANNAH FAYE WAWNER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantSC
2363A00000XPhysician Assistant3425SC

General Provider Information

NPI Number : 1104476944
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAVANNAH FAYE WAWNER PA-C
Provider Business Mailing Address
First Line : PO BOX 751461
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1461
Country : US
Telephone Number : 843-792-6200
Fax Number :
Provider Business Practice Location Address
First Line : 2250 MALL DR
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6563
Country : US
Telephone Number : 843-876-0444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2019
Last Update Date : 04/22/2020

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