Individual
LAURA WIERICHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
300 CALLEN BLVD STE 220, SUMMERVILLE, SC 29486-2816
(843) 884-8045
(843) 881-5081
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9318
GA
363AS0400X
Surgical Physician Assistant
Primary
4528
SC
Other
Enumeration date
07/09/2019
Last updated
11/10/2022
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