Healthcare Provider Details

I. General information

NPI: 1669784344
Provider Name (Legal Business Name): JESSICA SALEM ADAMS D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N 8TH AVE STE 2B
DILLON SC
29536
US

IV. Provider business mailing address

705 N 8TH AVE STE 2B
DILLON SC
29536-2549
US

V. Phone/Fax

Practice location:
  • Phone: 843-841-3846
  • Fax: 843-841-3848
Mailing address:
  • Phone: 843-841-3846
  • Fax: 843-841-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1669784344
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30964
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number82967
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: