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General NPI Number Information
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NPI Number | 1245822733
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Entity Type | Individual
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Provider Name | BRANDY JONES-MACK
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Gender | Female
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Dates
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Enumeration Date | 02/07/2021
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Last Update Date | 02/07/2021
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Provider Practice Location Address
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Address Line | 410 E MAIN ST
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City | SPARTANBURG
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State | SC
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Zip | 29302-1933
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Country | US
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Telephone | 864-504-7184
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Fax |
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Provider Business Mailing Address
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Address Line | 441 MELBOURNE LN
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City | SPARTANBURG
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State | SC
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Zip | 29301-3245
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Country | US
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Telephone | 864-504-7184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 78742
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License Number State | SC
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