Healthcare Provider Details

I. General information

NPI: 1063413136
Provider Name (Legal Business Name): JAMES LEE JEWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 EBENEZER RD
ROCK HILL SC
29732-2355
US

IV. Provider business mailing address

1218 AUBURNDALE LN
ROCK HILL SC
29732-9600
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-6648
  • Fax: 803-985-4134
Mailing address:
  • Phone: 803-366-4818
  • Fax: 803-366-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number12269
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: