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NPI Code Detail

MEDICARE: MARY K DECKER PA

MEDICARE: MARY K DECKER 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 Assistant710SC

General Provider Information

NPI Number : 1679501118
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY K DECKER PA
Provider Business Mailing Address
First Line : 4416 FOREST DR
Second Line : 2ND FLOOR
City : COLUMBIA
State : SC
Zip : 29206-3104
Country : US
Telephone Number : 803-782-4278
Fax Number : 803-782-3445
Provider Business Practice Location Address
First Line : 8091 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9236
Country : US
Telephone Number : 843-572-7000
Fax Number : 843-572-4070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 07/08/2007

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Directions to “ MARY K DECKER PA” Practice Location

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