Healthcare Provider Details

I. General information

NPI: 1629169214
Provider Name (Legal Business Name): JENNIFER ELIZABETH HEATH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER STAHL MD

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6863
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-4506
  • Fax: 803-434-1537
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number238986
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: