Provider Demographics
NPI:1063958775
Name:FREER, ELIZABETH V (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:V
Last Name:FREER
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 1:9 SMITH PL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1369
Mailing Address - Country:US
Mailing Address - Phone:717-521-8960
Mailing Address - Fax:
Practice Address - Street 1:7555 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4211
Practice Address - Country:US
Practice Address - Phone:843-797-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2678363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant