Provider Demographics
NPI:1871960104
Name:HAWVER, MELISSA LYNN (PA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNN
Last Name:HAWVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:HESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-6554
Mailing Address - Fax:864-560-7779
Practice Address - Street 1:1200 E MAIN ST STE 12
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1738
Practice Address - Country:US
Practice Address - Phone:864-560-9260
Practice Address - Fax:864-560-9265
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL2727363A00000X
SC2727363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2889PAMedicaid
SCSCA2186121OtherMEDICARE PTAN
SCSCA2186067OtherMEDICARE PTAN
SCSCA2185019OtherMEDICARE PIN
SCSCA218J577OtherMEDICARE PIN