Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 12269 | SC |
NPI | 1063413136 |
---|---|
Provider Name | Dr. James Lee Jewell |
First Address | Rock Hill, SC 29732-9600 |
Second Address | Rock Hill, SC 29732-2355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 29/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122691/GP2323 | (05) | SC |
C81626 | (02) |