Provider Demographics
NPI:1790988863
Name:YATES-JOHNSON, ANJINETTA (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANJINETTA
Middle Name:
Last Name:YATES-JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ANJINETTA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:900 BOWMAN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3203
Mailing Address - Country:US
Mailing Address - Phone:843-881-5844
Mailing Address - Fax:843-881-5012
Practice Address - Street 1:900 BOWMAN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3203
Practice Address - Country:US
Practice Address - Phone:843-881-5844
Practice Address - Fax:843-881-5012
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant