Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 877 | SC |
N | 208000000X | Pediatrician | 877 | SC |
NPI | 1134171655 |
---|---|
Provider Name | Julie S Jones |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS0379 | (05) | SC |
Q34002 | (02) | SC |