Healthcare Provider Details

I. General information

NPI: 1891779385
Provider Name (Legal Business Name): AMIE MICHELLE JAKUBIAK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 MCMILLAN ROAD
CLEMSON SC
29634-4054
US

IV. Provider business mailing address

BOX 344054
CLEMSON SC
29634-0001
US

V. Phone/Fax

Practice location:
  • Phone: 864-656-2233
  • Fax:
Mailing address:
  • Phone: 864-656-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36179
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101015339
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: