Crockett, Jay Anton

Crockett, Jay Anton is an individual health care provider with primary practice located at 60 Bear Dr , Greenville SC 29605-4458. He recently has only one registered license in Allopathic & Osteopathic Physicians / Colon & Rectal Surgery, which is considered as his primary health care specialty. Crockett, Jay Anton can be contacted via phone (864) 269-5500.

Contact Information

Primary practice address
60 Bear Dr Greenville SC 29605-4458
Phone: (864) 269-5500
Fax: (864) 269-8568
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 20317 South Carolina

Profile Details

NPI number 1538165287
LBN Legal business name Crockett, Jay Anton
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2005
Last updated Feb 2nd, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538165287 NPPES
South Carolina MEDICAID T46019
South Carolina Other 576007863136
South Carolina Other 576007863153
South Carolina Other P00802351

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