Healthcare Provider Details

I. General information

NPI: 1750153003
Provider Name (Legal Business Name): JAMALA SARAN WHITE CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 ROCK CREEK DR
FLORENCE SC
29505-6494
US

IV. Provider business mailing address

1104 ROCK CREEK DR
FLORENCE SC
29505-6494
US

V. Phone/Fax

Practice location:
  • Phone: 843-496-4000
  • Fax:
Mailing address:
  • Phone: 843-496-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberG6W7A4E5
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: