MEDICARE: ANNE MARIE GROWNEY 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	0110005610	VA

General Provider Information

NPI Number	:	1457897282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE MARIE GROWNEY PA-C

Provider Business Mailing Address
First Line	:	3280 HENDERSON DR STE C
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5290
Country	:	US
Telephone Number	:	910-914-8450
Fax Number	:	888-745-7026

Provider Business Practice Location Address
First Line	:	3280 HENDERSON DR STE C
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5290
Country	:	US
Telephone Number	:	910-915-8450
Fax Number	:	888-745-7026

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

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	08/24/2023

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