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General NPI Number Information
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NPI Number | 1689639247
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Entity Type | Organization
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Legal Business Name | JONATHAN L SACK, MD, PC
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 2 MARSHLAND RD
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City | HILTON HEAD
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State | SC
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Zip | 29926-2305
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Country | US
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Telephone | 843-842-6357
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Fax | 843-842-6352
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Provider Business Mailing Address
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Address Line | 2 MARSHLAND RD
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City | HILTON HEAD
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State | SC
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Zip | 29926-2305
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Country | US
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Telephone | 843-842-6357
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Fax | 843-842-6352
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JONATHAN L SACK
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Credential | MD
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Telephone | 843-842-6357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | SC
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