Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 3444 | SC |
NPI | 1144392408 |
---|---|
Provider Name | Jennifer Mayfield |
First Address | Myrtle Beach, SC 29588-7113 |
Second Address | Myrtle Beach, SC 29588-7113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |