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General NPI Number Information
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NPI Number | 1740626621
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Entity Type | Organization
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Legal Business Name | JMP FAMILY PRACTICE INCORPORATED
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 3304 FOREST DR
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City | COLUMBIA
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State | SC
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Zip | 29204-4024
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Country | US
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Telephone | 803-787-3901
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Fax | 803-787-3902
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Provider Business Mailing Address
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Address Line | PO BOX 290192
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City | COLUMBIA
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State | SC
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Zip | 29229-0004
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Country | US
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Telephone | 803-787-3901
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Fax | 803-787-3902
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DAWN RICHARDSON
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Credential |
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Telephone | 803-386-6374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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