Individual
AMY ROSE HANCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
4900 OLEANDER DR, SUITE # 1, MYRTLE BEACH, SC 29577-5897
(864) 343-2609
(864) 546-4506
Mailing address
200 E BROAD ST, SUITE # 220, GREENVILLE, SC 29601-2887
(864) 343-2609
(864) 546-4506
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
OA002612
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2433
SOUTH CAROLINA MEDICAL LICENSE
SC
01
—
PN084501L
PA STATE LICENSE
PA
Enumeration date
08/30/2006
Last updated
06/02/2016
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