MEDICARE: EDITH BARRETT WILLIS 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
1	363A00000X	Physician Assistant	1853	SC

General Provider Information

NPI Number	:	1245584606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH BARRETT WILLIS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 751461
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1461
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 SAM RITTENBERG BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4616
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	08/28/2025

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Directions to “ EDITH BARRETT WILLIS PA-C” Practice Location

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