Healthcare Provider Details

I. General information

NPI: 1255333548
Provider Name (Legal Business Name): COUNTY OF JASPER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 GRAYS HWY
RIDGELAND SC
29936-5441
US

IV. Provider business mailing address

1509 GRAYS HWY
RIDGELAND SC
29936-5441
US

V. Phone/Fax

Practice location:
  • Phone: 843-726-7607
  • Fax: 843-726-7784
Mailing address:
  • Phone: 843-726-7607
  • Fax: 843-726-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number123
License Number StateSC

VIII. Authorized Official

Name: ANDREW FULGHUM
Title or Position: COUNTY ADMINISTRATOR
Credential:
Phone: 843-726-7607