Healthcare Provider Details

I. General information

NPI: 1003861881
Provider Name (Legal Business Name): JESSICA D. TOWNSEND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W SOUTH ST
MANNING SC
29102-2925
US

IV. Provider business mailing address

360 N IRBY ST
FLORENCE SC
29501-2808
US

V. Phone/Fax

Practice location:
  • Phone: 803-433-4321
  • Fax: 803-433-0075
Mailing address:
  • Phone: 843-667-9414
  • Fax: 843-667-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27096
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: