Healthcare Provider Details

I. General information

NPI: 1821089103
Provider Name (Legal Business Name): JANE VANCE GWINN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CREEKVIEW CT
GREENVILLE SC
29615-4800
US

IV. Provider business mailing address

PO BOX 2145
SKYLAND NC
28776-2145
US

V. Phone/Fax

Practice location:
  • Phone: 864-458-7431
  • Fax: 864-458-7463
Mailing address:
  • Phone: 828-575-2644
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number11118
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: