Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20821 | SC |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 20821 | SC |
NPI | 1366448771 |
---|---|
Provider Name | Dr. John Russell Fleming JR. |
First Address | Sumter, SC 29150-1732 |
Second Address | Sumter, SC 29150-1970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 17/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G30613 | (02) | SC |
T49196 | (05) | SC |