MEDICARE: HANNAH BROOKE WOODS 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
1	363A00000X	Physician Assistant	5080	SC

General Provider Information

NPI Number	:	1760264469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH BROOKE WOODS PA

Provider Business Mailing Address
First Line	:	1590 FREEDOM BLVD STE B
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29505-6071
Country	:	US
Telephone Number	:	843-665-9581
Fax Number	:

Provider Business Practice Location Address
First Line	:	1590 FREEDOM BLVD
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29505-6071
Country	:	US
Telephone Number	:	843-621-2287
Fax Number	:

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

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	06/04/2026

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