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General NPI Number Information
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NPI Number | 1720883093
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Entity Type | Individual
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Provider Name | JACKSON COHEN PURVIS
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Gender | Male
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 851 E CHEVES ST
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City | FLORENCE
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State | SC
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Zip | 29506-2632
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Country | US
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Telephone | 843-777-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 4630 ARMFIELD RD
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City | EFFINGHAM
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State | SC
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Zip | 29541-5043
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Country | US
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Telephone | 843-621-1327
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 29995
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License Number State | SC
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