Healthcare Provider Details

I. General information

NPI: 1033609268
Provider Name (Legal Business Name): JESSICA ISAAC DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 SUNSET CT STE 200
WEST COLUMBIA SC
29169-2464
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-314-9360
  • Fax: 803-314-9361
Mailing address:
  • Phone: 803-314-9360
  • Fax: 803-314-9361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2021-01993
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number95560
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: