Healthcare Provider Details

I. General information

NPI: 1366448771
Provider Name (Legal Business Name): JOHN RUSSELL FLEMING JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 ALICE DR
SUMTER SC
29150-1970
US

IV. Provider business mailing address

1035 FOXRIDGE CT
SUMTER SC
29150-1732
US

V. Phone/Fax

Practice location:
  • Phone: 803-905-2273
  • Fax: 803-905-7775
Mailing address:
  • Phone: 803-236-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20821
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number20821
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: