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General NPI Number Information
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NPI Number | 1952945636
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Entity Type | Organization
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Legal Business Name | JAG MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 105 S CEDAR ST STE G
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City | SUMMERVILLE
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State | SC
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Zip | 29483-6078
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Country | US
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Telephone | 619-933-5382
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Fax |
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Provider Business Mailing Address
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Address Line | 1219 RAVEN RD
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City | HANAHAN
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State | SC
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Zip | 29410-8509
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Country | US
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Telephone | 619-933-5382
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JARED GUICHARD
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Credential | MD
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Telephone | 619-933-5382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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