Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2970 | SC |
NPI | 1548574213 |
---|---|
Provider Name | Mr. Wilbur Jay Jones JR. |
First Address | Summerville, SC 29483-4923 |
Second Address | Charleston, SC 29401-1113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2010 |
Last Update Date | 04/08/2010 |