Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 10938 | SC |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 10938 | SC |
NPI | 1396702452 |
---|---|
Provider Name | Dr. James E. Jennings JR. |
First Address | Greenville, SC 29615-4816 |
Second Address | Greenville, SC 29615-4816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 12/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
109386 | (05) | SC |
1295769438 | GROUP NPI (01) | SC |
8157 | MEDICARE PTAN (01) | SC |
D05624 | (02) | SC |