Individual
MRS. MEGAN WILDEROTTER ACKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
120 GATEWAY CORPORATE BLVD, EMERGENCY DEPARTMENT, COLUMBIA, SC 29203-9611
(803) 256-5300
Mailing address
120 GATEWAY CORPORATE BLVD, EMERGENCY DEPARTMENT, COLUMBIA, SC 29203-9611
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
307587
LA
363AM0700X
Medical Physician Assistant
Primary
307587
LA
363AM0700X
Medical Physician Assistant
PA2122
SC
Other
Enumeration date
06/19/2014
Last updated
04/20/2021
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