Individual
RAEGAN DENAE CHAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-7025
(864) 560-7388
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4841
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6374PA
—
SC
01
—
SCQ5368510
MEDICARE PIN
SC
01
—
SCQ5369068
MEDICARE PIN
SC
Enumeration date
08/04/2023
Last updated
01/22/2025
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