=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861211815
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIYAH ALSTON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2024
-----------------------------------------------------
Last Update Date | 10/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15240 NEWBERRY RD
-----------------------------------------------------
City | BLAIR
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29015-9677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-608-2620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15240 NEWBERRY RD
-----------------------------------------------------
City | BLAIR
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29015-9677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-608-2620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | 9981211
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------