Provider Demographics
NPI:1124264874
Name:BARNETTE, GLORIA JC (PA-C)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JC
Last Name:BARNETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:125 DOUGHTY ST STE 280
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5727
Mailing Address - Country:US
Mailing Address - Phone:843-577-6957
Mailing Address - Fax:843-266-2068
Practice Address - Street 1:125 DOUGHTY ST STE 280
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5727
Practice Address - Country:US
Practice Address - Phone:843-577-6957
Practice Address - Fax:843-266-2068
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC407HEM363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical