Individual
AMMON WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
602 N MAIN ST, SUMMERVILLE, SC 29483-6627
(843) 881-4440
(843) 225-0110
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10420324-1206
UT
363A00000X
Physician Assistant
Primary
4778
SC
Other
Enumeration date
06/15/2017
Last updated
11/20/2024
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