Provider Demographics
NPI:1437923075
Name:HALTER, SAVANNAH (PA-C)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:HALTER
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 1:2850 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9192
Mailing Address - Country:US
Mailing Address - Phone:843-863-1188
Mailing Address - Fax:843-863-8286
Practice Address - Street 1:2850 TRICOM ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9192
Practice Address - Country:US
Practice Address - Phone:843-863-1188
Practice Address - Fax:843-863-8286
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5087363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical