Healthcare Provider Details

I. General information

NPI: 1881775286
Provider Name (Legal Business Name): MRS. JAMIE LYNN KORNEGAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2267 ASHLEY RIVER RD
CHARLESTON SC
29414-4736
US

IV. Provider business mailing address

5111 N RHETT AVE
NORTH CHARLESTON SC
29405-4219
US

V. Phone/Fax

Practice location:
  • Phone: 843-576-4121
  • Fax: 843-793-3575
Mailing address:
  • Phone: 843-576-4121
  • Fax: 843-793-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5754
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: