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NPI Code Detail

MEDICARE: MRS. JILL M PETERSON M.D.

MEDICARE: MRS. JILL M PETERSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician23562SC

General Provider Information

NPI Number : 1134203326
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILL M PETERSON M.D.
Provider Business Mailing Address
First Line : PO BOX 602108
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-2108
Country : US
Telephone Number : 843-792-6200
Fax Number :
Provider Business Practice Location Address
First Line : 602 N MAIN ST
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29483-6627
Country : US
Telephone Number : 843-876-2121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 04/03/2014

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