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General NPI Number Information
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NPI Number | 1912225004
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Entity Type | Individual
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Provider Name | JARROD CHEVALIER FRITZ LMT
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Gender | Male
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 1064 GARDNER RD STE 313
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City | CHARLESTON
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State | SC
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Zip | 29407-5768
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Country | US
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Telephone | 843-813-1200
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Fax | 843-852-9949
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Provider Business Mailing Address
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Address Line | 1064 GARDNER RD. STE 313
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City | CHARLESTON
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State | SC
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Zip | 29407
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Country | US
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Telephone | 843-813-1200
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Fax | 843-852-9949
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 3692
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 20-4692852
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License Number State | SC
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