Healthcare Provider Details

I. General information

NPI: 1205367166
Provider Name (Legal Business Name): JESSICA RACHEL HIMMELSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 N A ST
EASLEY SC
29640-2142
US

IV. Provider business mailing address

704 N A ST
EASLEY SC
29640-2142
US

V. Phone/Fax

Practice location:
  • Phone: 864-859-4480
  • Fax:
Mailing address:
  • Phone: 864-859-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number88282
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: