Healthcare Provider Details

I. General information

NPI: 1962117648
Provider Name (Legal Business Name): JESSICA TURNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 TAYLOR ST STE B
COLUMBIA SC
29204-1006
US

IV. Provider business mailing address

2018 TAYLOR ST STE B
COLUMBIA SC
29204-1006
US

V. Phone/Fax

Practice location:
  • Phone: 803-368-4650
  • Fax:
Mailing address:
  • Phone: 803-368-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRC65296
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: