Healthcare Provider Details

I. General information

NPI: 1871994327
Provider Name (Legal Business Name): JO LINDA HAMMETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JO LINDA REYES APRN, FNP-C

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MILLS AVENUE AGAPE PHYSICIANS CARE
GREENVILLE SC
29605
US

IV. Provider business mailing address

1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC., DBA AGAPE PHYSICIANS C
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 843-751-6430
  • Fax: 864-751-6424
Mailing address:
  • Phone: 803-454-0365
  • Fax: 803-404-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19057
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: