Healthcare Provider Details

I. General information

NPI: 1003873779
Provider Name (Legal Business Name): W. CLARK JERNIGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 HIGHWAY 153
PIEDMONT SC
29673-9498
US

IV. Provider business mailing address

3150 HIGHWAY 153
PIEDMONT SC
29673-9498
US

V. Phone/Fax

Practice location:
  • Phone: 864-295-1231
  • Fax:
Mailing address:
  • Phone: 864-295-1231
  • Fax: 864-295-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10939
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: