Individual
RYAN CHRISTOPHER WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
48 CENTENNIAL WAY, GREENVILLE, SC 29605-4662
(864) 455-1600
(864) 522-8005
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MPA.3134
SC
363AS0400X
Surgical Physician Assistant
MPA.3134
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3893PA
—
SC
Enumeration date
01/07/2019
Last updated
05/06/2021
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