Healthcare Provider Details

I. General information

NPI: 1811539349
Provider Name (Legal Business Name): JILLIAN MARY KOVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WILLIAM POPE DR STE 5
BLUFFTON SC
29909-7550
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 843-705-9440
  • Fax: 843-705-9445
Mailing address:
  • Phone: 423-541-5491
  • Fax: 423-551-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2637
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: