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NPI Code Detail

MEDICARE: MRS. ANJINETTA YATES-JOHNSON P.A.

MEDICARE: MRS. ANJINETTA YATES-JOHNSON P.A.
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 Assistant712SC

General Provider Information

NPI Number : 1790988863
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANJINETTA YATES-JOHNSON P.A.
Provider Business Mailing Address
First Line : 900 BOWMAN RD
Second Line : SUITE 103
City : MOUNT PLEASANT
State : SC
Zip : 29464-3203
Country : US
Telephone Number : 843-881-5844
Fax Number : 843-881-5012
Provider Business Practice Location Address
First Line : 900 BOWMAN RD
Second Line : SUITE 103
City : MOUNT PLEASANT
State : SC
Zip : 29464-3203
Country : US
Telephone Number : 843-881-5844
Fax Number : 843-881-5012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2007
Last Update Date : 07/08/2007

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