Weaver, Stacy W

Weaver, Stacy W is an individual health care provider with primary practice located at 1619 Carolina Ave , Orangeburg SC 29115-4939. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Weaver, Stacy W can be contacted via phone (803) 537-7474.

Contact Information

Primary practice address
1619 Carolina Ave Orangeburg SC 29115-4939
Phone: (803) 537-7474
Fax: (803) 531-7457
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1829 South Carolina

Profile Details

NPI number 1609127075
LBN Legal business name Weaver, Stacy W
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2012
Last updated Apr 23rd, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609127075 NPPES
South Carolina MEDICAID GP5343
South Carolina Other 018

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