Provider Demographics
NPI:1538563408
Name:BREWSTER, REBECCA (PA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-350-7412
Mailing Address - Fax:912-350-7297
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-7412
Practice Address - Fax:912-350-7297
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10397I7383OtherMEDICARE PTAN
GAPENDINGOtherMEDICARE PTAN
GAPENDINGOtherMEDICARE PTAN