Individual
CARLY SCHNEIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 SASANQUA DR, GRANITEVILLE, SC 29829
(803) 392-1811
(803) 761-6247
Mailing address
367 S. GULPH RD, ATTN: IPM CREDENTIALING, KING OF PRUSSIA, PA 19406-3121
(803) 392-1811
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1873
SC
Other
Enumeration date
01/07/2013
Last updated
03/11/2019
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