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General NPI Number Information
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NPI Number | 1891828133
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Entity Type | Individual
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Provider Name | JEROD LINDSEY LUNSFORD M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 05/19/2024
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Provider Practice Location Address
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Address Line | 114 GATEWAY CORPORATE BLVD STE 450
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City | COLUMBIA
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State | SC
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Zip | 29203-9785
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Country | US
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Telephone | 803-865-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 114 GATEWAY CORPORATE BLVD STE 450
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City | COLUMBIA
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State | SC
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Zip | 29203-9785
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Country | US
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Telephone | 803-865-4950
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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 | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | 29037
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License Number State | SC
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