Basic Information
| Provider Information | |||||||||
| NPI: | 1912403528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRIDE | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296463869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647254865 | ||||||||
| FaxNumber: | 8647254883 | ||||||||
| Practice Location | |||||||||
| Address1: | 146 E HOSPITAL DR STE 140&350 | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291694800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039367966 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2018 | ||||||||
| LastUpdateDate: | 07/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 52681 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | 52681 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.