Individual
MICHAEL R. STAVERSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3495 IRON HORSE RD, LADSON, SC 29456-4319
(843) 793-5970
(843) 419-5391
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(843) 695-6071
(843) 569-5879
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3892
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4578PA
—
SC
Enumeration date
11/09/2020
Last updated
04/26/2024
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