Provider Demographics
NPI:1578711081
Name:HALBRITTER, MARY L (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:HALBRITTER
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:PO BOX 741221
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1221
Mailing Address - Country:US
Mailing Address - Phone:803-641-5651
Mailing Address - Fax:803-641-5625
Practice Address - Street 1:302 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6302
Practice Address - Country:US
Practice Address - Phone:803-641-5651
Practice Address - Fax:803-641-5625
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0858PAMedicaid
SCAA31959636Medicare PIN