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General NPI Number Information
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NPI Number | 1861066367
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Entity Type | Individual
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Provider Name | JACOB CHARLES ANDREWS DO
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Gender | Male
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 600 BEVERLY HANKS CTR
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City | HENDERSONVILLE
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State | NC
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Zip | 28792-2305
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Country | US
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Telephone | 828-693-3296
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Fax |
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Provider Business Mailing Address
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Address Line | PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER 14 MEDICAL PARK, STE 400
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City | COLUMBIA
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State | SD
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Zip | 29203
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Country | US
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Telephone | 803-434-6155
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Fax | 803-434-6979
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | LL83629
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 202401845
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License Number State | NC
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