Individual
LONDON JUDITH MICCICHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
180 WINGO WAY STE 207, MOUNT PLEASANT, SC 29464-1811
(843) 884-5101
(843) 606-7997
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(888) 472-0043
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4588
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5930PA
—
SC
Enumeration date
09/20/2022
Last updated
09/25/2025
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