Provider Demographics
NPI:1225305345
Name:BOTTS, REBECCA G (PAC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:G
Last Name:BOTTS
Suffix:
Gender:F
Credentials:PAC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 W GREENWOOD ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5717
Mailing Address - Country:US
Mailing Address - Phone:864-366-9681
Mailing Address - Fax:864-366-5600
Practice Address - Street 1:901 W GREENWOOD ST STE 1
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5727
Practice Address - Country:US
Practice Address - Phone:864-366-9681
Practice Address - Fax:864-366-5600
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant