Healthcare Provider Details

I. General information

NPI: 1922269109
Provider Name (Legal Business Name): JEFFREY T. TUBBS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST 6TH FLOOR
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2842
  • Fax: 843-724-1995
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberMD 35533
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: