Healthcare Provider Details

I. General information

NPI: 1235266826
Provider Name (Legal Business Name): JEREMY J PARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E WOOD ST
SPARTANBURG SC
29303-3040
US

IV. Provider business mailing address

PO BOX 30637
CHARLOTTE NC
28230-0637
US

V. Phone/Fax

Practice location:
  • Phone: 704-973-5515
  • Fax: 704-973-5518
Mailing address:
  • Phone: 704-973-5515
  • Fax: 704-973-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number27087
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number27087
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: