Healthcare Provider Details

I. General information

NPI: 1467363218
Provider Name (Legal Business Name): JIYA JACOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 QUEENSHIRE LN
ELGIN SC
29045-7148
US

IV. Provider business mailing address

837 QUEENSHIRE LN
ELGIN SC
29045-7148
US

V. Phone/Fax

Practice location:
  • Phone: 803-463-9857
  • Fax:
Mailing address:
  • Phone: 803-463-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: