Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1003356213 |
---|---|
Provider Name | Mrs. Jillian Jenay Mays |
First Address | Summerville, SC 29485-4900 |
Second Address | Summerville, SC 29485-4900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2017 |
Last Update Date | 07/03/2017 |