Provider Demographics
NPI:1932295912
Name:MIDDLETON, CHERYL WILLIS (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:WILLIS
Last Name:MIDDLETON
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 1:838 POWDERSVILLE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3703
Mailing Address - Country:US
Mailing Address - Phone:864-850-9988
Mailing Address - Fax:864-850-9989
Practice Address - Street 1:838 POWDERSVILLE RD
Practice Address - Street 2:SUITE G
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3703
Practice Address - Country:US
Practice Address - Phone:864-850-9988
Practice Address - Fax:864-850-9989
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA385363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCA385OtherSTATE LICENSE
SCA385OtherSTATE LICENSE