Healthcare Provider Details

I. General information

NPI: 1699809475
Provider Name (Legal Business Name): JODI ANN MEMERY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MEADOWLARK ST 20TH MEDICAL GROUP MENTAL HEALTH CLINIC
SHAW AFB SC
29152-5019
US

IV. Provider business mailing address

590 YUMA CT
SUMTER SC
29150-2252
US

V. Phone/Fax

Practice location:
  • Phone: 803-895-6199
  • Fax:
Mailing address:
  • Phone: 325-864-0269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: