Individual
JANA UPSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
966 HOUSTON NORTHCUTT BLVD STE E, MOUNT PLEASANT, SC 29464-3487
(843) 471-0375
(843) 806-4300
Mailing address
2880 TRICOM ST, NORTH CHARLESTON, SC 29406-9171
(843) 797-5050
(843) 797-3633
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
18649
SC
208000000X
Pediatrics Physician
2010-01542
NC
2080S0010X
Pediatric Sports Medicine Physician
18649
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186499
—
SC
Enumeration date
08/29/2006
Last updated
03/11/2020
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