Provider Demographics
NPI:1043283575
Name:HEARN, SARAH E (PAC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:E
Last Name:HEARN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 HUTTO ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-1467
Mailing Address - Country:US
Mailing Address - Phone:803-531-1516
Mailing Address - Fax:803-531-1523
Practice Address - Street 1:1181 HUTTO ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1467
Practice Address - Country:US
Practice Address - Phone:803-531-1516
Practice Address - Fax:803-531-1523
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0096PAMedicaid
P28675Medicare UPIN