Individual
MARY S. MACDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2085 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-7710
(843) 577-6957
(843) 577-6523
Mailing address
PO BOX 751874, CHARLOTTE, NC 28275-1874
(843) 402-5200
(843) 402-5296
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
740
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5276PA
—
SC
Enumeration date
10/03/2006
Last updated
09/18/2025
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