Individual
YVANNAH MAE GARCIA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
114 GATEWAY CORPORATE BLVD STE 420, COLUMBIA, SC 29203-9785
(803) 365-8650
Mailing address
PO BOX 935722, ATLANTA, GA 31193-5722
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3304
SC
363AM0700X
Medical Physician Assistant
PA3304
SC
363AS0400X
Surgical Physician Assistant
3304
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3956PA
—
SC
Enumeration date
10/19/2018
Last updated
09/16/2025
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