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General NPI Number Information
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NPI Number | 1881657153
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Entity Type | Individual
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Provider Name | JERRY S. PURCELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 1208 ELLA ST
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City | ANDERSON
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State | SC
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Zip | 29621-4839
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Country | US
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Telephone | 864-965-9150
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Fax | 864-965-9654
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Provider Business Mailing Address
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Address Line | 1208 ELLA ST
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City | ANDERSON
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State | SC
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Zip | 29621-4839
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Country | US
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Telephone | 864-965-9150
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Fax | 864-659-6549
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21864
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License Number State | SC
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