Basic Information
Provider Information
NPI: 1225672488
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARRINGTON
FirstName: REBEKAH
MiddleName: CHRISTINE
NamePrefix: MRS.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GRUBBS
OtherFirstName: REBEKAH
OtherMiddleName: CHRISTINE
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1 INDEPENDENCE PT STE 212
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296154536
CountryCode: US
TelephoneNumber: 8647976308
FaxNumber:  
Practice Location
Address1: 701 GROVE RD FL 1
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296054210
CountryCode: US
TelephoneNumber: 8644557899
FaxNumber: 8644555474
Other Information
ProviderEnumerationDate: 10/31/2019
LastUpdateDate: 12/05/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X3414SCY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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