Provider Demographics
NPI:1992772982
Name:IRWIN, REBECCA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:IRWIN
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 1:2500 STARLING STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-466-5303
Mailing Address - Fax:912-261-4741
Practice Address - Street 1:2500 STARLING STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-466-5303
Practice Address - Fax:912-261-4741
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA431824101AMedicaid
GA97WCHKWMedicare ID - Type Unspecified
GA431824101AMedicaid