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General NPI Number Information
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NPI Number | 1508825035
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Entity Type | Individual
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Provider Name | WILLIAM RUSSELL JENNINGS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 5 MEDICAL PARK DRIVE STE 350 PALMETTO HEALTH RICHLAND DEPT OF EMERGENCY MED
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City | COLUMBIA
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State | SC
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Zip | 29203
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Country | US
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Telephone | 803-434-6690
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Fax | 803-434-3946
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Provider Business Mailing Address
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Address Line | 5 MEDICAL PARK DRIVE DEPT OF EMERGENCY MEDICINE PALMETTO HEALTH RICHLAND
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City | COLUMBIA
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State | SC
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Zip | 29203
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Country | US
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Telephone | 803-434-6690
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Fax | 803-434-3946
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 24096
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License Number State | SC
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