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General NPI Number Information
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NPI Number | 1851900047
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Entity Type | Individual
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Provider Name | MR. JACOB LOUIS SLANN
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Gender | Male
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 408 COLLEGE AVE
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City | CLEMSON
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State | SC
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Zip | 29631-1441
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Country | US
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Telephone | 864-650-0804
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Fax |
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Provider Business Mailing Address
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Address Line | 408 COLLEGE AVE
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City | CLEMSON
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State | SC
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Zip | 29631-1441
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Country | US
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Telephone | 864-650-0804
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 303469
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License Number State | TX
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