Provider Demographics
NPI:1225671860
Name:MCDEVITT, MIKAILA MARION (PA)
Entity Type:Individual
Prefix:
First Name:MIKAILA
Middle Name:MARION
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MIKAILA
Other - Middle Name:
Other - Last Name:SZWED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK RD STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6839
Practice Address - Country:US
Practice Address - Phone:803-434-8800
Practice Address - Fax:803-929-0492
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant