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General NPI Number Information
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NPI Number | 1366682254
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Entity Type | Individual
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Provider Name | JONATHAN PHILIP ELIAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 435 MARINA DR
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City | GEORGETOWN
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State | SC
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Zip | 29440-2410
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Country | US
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Telephone | 843-833-8595
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Fax | 843-833-8599
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Provider Business Mailing Address
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Address Line | PO BOX 1807
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City | GEORGETOWN
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State | SC
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Zip | 29442-1807
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Country | US
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Telephone | 843-833-8595
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Fax | 843-833-8599
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 31380
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License Number State | SC
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