Jennings, Lisa D

Jennings, Lisa D is an individual health care provider with primary practice located at 219A N Mine St , Mc Cormick SC 29835-8363. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Jennings, Lisa D can be contacted via phone (864) 852-3336.

Contact Information

Primary practice address
219A N Mine St Mc Cormick SC 29835-8363
Phone: (864) 852-3336
Fax: (864) 852-3339
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 053559 Georgia

Profile Details

NPI number 1255324190
LBN Legal business name Jennings, Lisa D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 25th, 2005
Last updated Sep 18th, 2013 - about 13 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 1255324190 NPPES
Georgia MEDICAID 166197103A
Georgia MEDICAID 166197103B
Georgia MEDICAID 166197103C
Georgia MEDICAID 166197103D

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