Provider Demographics
NPI:1114099306
Name:PAGE, ANNIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 SUMTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29207-6102
Mailing Address - Country:US
Mailing Address - Phone:803-751-7779
Mailing Address - Fax:
Practice Address - Street 1:2179 SUMTER AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-6102
Practice Address - Country:US
Practice Address - Phone:803-751-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant