Healthcare Provider Details

I. General information

NPI: 1619677218
Provider Name (Legal Business Name): JARVIA BREONNE MEGGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 RIVERSIDE DR
CHARLESTON SC
29403-3249
US

IV. Provider business mailing address

40 RIVERSIDE DR
CHARLESTON SC
29403-3249
US

V. Phone/Fax

Practice location:
  • Phone: 843-737-3570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number255737
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: