Provider Demographics
NPI:1427209782
Name:GRIFFITH, WENDY S (PA-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:GRIFFITH
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 1:2998 W MONTAGUE AVE
Mailing Address - Street 2:# 117
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5931
Mailing Address - Country:US
Mailing Address - Phone:843-747-4313
Mailing Address - Fax:
Practice Address - Street 1:1049B ANNA KNAPP BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3133
Practice Address - Country:US
Practice Address - Phone:843-747-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1341363AM0700X
SC944133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-1114139OtherEIN
SCAA3254Medicare UPIN
SCAA32547041Medicare PIN