Individual
MRS. EMMA GRACE RAIDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2857
SC
363AM0700X
Medical Physician Assistant
C0006234
MD
Other
Enumeration date
10/04/2016
Last updated
11/16/2017
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