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NPI Code Detail

MEDICARE: HENRY B SPRADLIN PA

MEDICARE: HENRY B SPRADLIN PA
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 Assistant1041SC

General Provider Information

NPI Number : 1649461138
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY B SPRADLIN PA
Provider Business Mailing Address
First Line : 8740 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9211
Country : US
Telephone Number : 843-572-5990
Fax Number : 843-572-2928
Provider Business Practice Location Address
First Line : 8740 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9211
Country : US
Telephone Number : 843-572-5990
Fax Number : 843-572-2928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2007
Last Update Date : 12/31/2015

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