Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 20679 | SC |
NPI | 1003875717 |
---|---|
Provider Name | Jeffrey Kirk Hensarling |
First Address | Greenville, SC 29601-2842 |
Second Address | Seneca, SC 29678-4546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200045060 | RR MEDICARE (01) | SC |
206798 | (05) | SC |
431476513 | BCBS (01) | SC |
H43532 | (02) | SC |