Healthcare Provider Details

I. General information

NPI: 1568541977
Provider Name (Legal Business Name): FRITZ MORGAN JERNIGAN L.M.B.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 E LEWIS PLZ
GREENVILLE SC
29605-2942
US

IV. Provider business mailing address

50 CLARK RD
TAYLORS SC
29687-5927
US

V. Phone/Fax

Practice location:
  • Phone: 864-370-3325
  • Fax:
Mailing address:
  • Phone: 864-320-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3437
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: