Individual
MRS. ERICA LEE DOMOGAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3361 HIGHWAY 9 E, LITTLE RIVER, SC 29566-7826
(843) 497-5929
(866) 778-9612
Mailing address
PO BOX 3439, NORTH MYRTLE BEACH, SC 29582-0439
(843) 839-6379
(843) 399-0123
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TL3218
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679036925
—
NC
05
—
3167PA
—
SC
Enumeration date
04/12/2019
Last updated
03/07/2023
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