Basic Information
| Provider Information | |||||||||
| NPI: | 1386871655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAMISON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | GRIER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1409 W GEORGIA RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SIMPSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296806419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644545000 | ||||||||
| FaxNumber: | 8644545005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2009 | ||||||||
| LastUpdateDate: | 08/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | BP10033766 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | P2011 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35412 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 354128 | 05 | SC | MEDICAID |