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1801865365

NPI Code Detail

MEDICARE: DR. CHARLES STEWART JERVEY M. D.

MEDICARE: DR. CHARLES STEWART JERVEY 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
1	2084N0400X	Neurology Physician	2020001526	MO
2	2084N0400X	Neurology Physician	15014	SC
3	2084N0400X	Neurology Physician	0101268933	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801865365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES STEWART JERVEY M. D.

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT STE 212
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4536
Country	:	US
Telephone Number	:	864-797-6307
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 PATEWOOD DR STE B350
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-6337
Country	:	US
Telephone Number	:	864-454-4500
Fax Number	:	864-454-4505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	01/30/2024

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1043343692 — MR. THOMAS C PERRY JR. MD
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Directions to “ DR. CHARLES STEWART JERVEY M. D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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