Healthcare Provider Details

I. General information

NPI: 1891828133
Provider Name (Legal Business Name): JEROD LINDSEY LUNSFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/19/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 GATEWAY CORPORATE BLVD STE 450
COLUMBIA SC
29203-9785
US

IV. Provider business mailing address

114 GATEWAY CORPORATE BLVD STE 450
COLUMBIA SC
29203-9785
US

V. Phone/Fax

Practice location:
  • Phone: 803-865-4950
  • Fax:
Mailing address:
  • Phone: 803-865-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number29037
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: