Provider Demographics
NPI:1336423599
Name:POULOS, DREWID PLYER (PA-C)
Entity Type:Individual
Prefix:
First Name:DREWID
Middle Name:PLYER
Last Name:POULOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DREWID
Other - Middle Name:DYNEANE
Other - Last Name:PLYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 603898
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3898
Mailing Address - Country:US
Mailing Address - Phone:803-581-2800
Mailing Address - Fax:
Practice Address - Street 1:517 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-8644
Practice Address - Country:US
Practice Address - Phone:803-581-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant