Provider Demographics
NPI:1497787386
Name:HUFFAKER, STEPHEN L (PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:HUFFAKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 VINE CREST CT
Mailing Address - Street 2:STE 500
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-8031
Mailing Address - Country:US
Mailing Address - Phone:864-227-8932
Mailing Address - Fax:
Practice Address - Street 1:105 VINE CREST CT
Practice Address - Street 2:STE 500
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-8031
Practice Address - Country:US
Practice Address - Phone:864-227-8932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC387363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3771Medicaid
SCGP3771Medicaid