Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 18649 | SC |
N | 208000000X | Pediatrician | 2010-01542 | NC |
NPI | 1093823957 |
---|---|
Provider Name | Jana Upshaw |
First Address | North Charleston, SC 29406-9171 |
Second Address | Mount Pleasant, SC 29464-3487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
186499 | (05) | SC |
G85939 | (02) |