Provider Demographics
NPI:1407378508
Name:DARROUDI, REBECCA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:DARROUDI
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:900 MOHAWK STREET
Mailing Address - Street 2:STE E
Mailing Address - City:SAVANNAH
Mailing Address - State:CA
Mailing Address - Zip Code:31419
Mailing Address - Country:US
Mailing Address - Phone:912-925-0067
Mailing Address - Fax:912-925-2381
Practice Address - Street 1:176 DERMIS RD
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927
Practice Address - Country:US
Practice Address - Phone:843-208-2055
Practice Address - Fax:912-927-0267
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2021-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCTL2771207Q00000X
SCPA22771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine