Healthcare Provider Details

I. General information

NPI: 1194321398
Provider Name (Legal Business Name): JENNIFER BLUM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST STE 3600
ANDERSON SC
29621-1725
US

IV. Provider business mailing address

2000 E GREENVILLE ST STE 3600
ANDERSON SC
29621-1725
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-1916
  • Fax:
Mailing address:
  • Phone: 864-512-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number95550
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: