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General NPI Number Information
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NPI Number | 1568830149
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Entity Type | Organization
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Legal Business Name | J & C MOBILE, LLC
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Dates
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Enumeration Date | 09/12/2015
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Last Update Date | 09/12/2015
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Provider Practice Location Address
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Address Line | 333 WHITES CREEK RD 333 WHITES CREEK ROAD
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City | GEORGETOWN
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State | SC
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Zip | 29440-4544
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Country | US
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Telephone | 800-240-1642
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Fax | 800-461-4096
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Provider Business Mailing Address
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Address Line | PO BOX 2401 333 WHITES CREEK ROAD
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City | GEORGETOWN
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State | SC
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Zip | 29442-2401
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Country | US
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Telephone | 800-240-1642
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Fax | 800-461-4096
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CELIA KNOWLIN RUTLEDGE
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Credential | MASTER DEGREE
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Telephone | 800-240-1642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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