Healthcare Provider Details

I. General information

NPI: 1508825035
Provider Name (Legal Business Name): WILLIAM RUSSELL JENNINGS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MEDICAL PARK DRIVE STE 350 PALMETTO HEALTH RICHLAND DEPT OF EMERGENCY MED
COLUMBIA SC
29203
US

IV. Provider business mailing address

5 MEDICAL PARK DRIVE DEPT OF EMERGENCY MEDICINE PALMETTO HEALTH RICHLAND
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6690
  • Fax: 803-434-3946
Mailing address:
  • Phone: 803-434-6690
  • Fax: 803-434-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number24096
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: