Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 27096 | SC |
NPI | 1003861881 |
---|---|
Provider Name | Jessica D. Townsend |
First Address | Florence, SC 29501-2808 |
Second Address | Manning, SC 29102-2925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 18/01/2018 |