Organization
JON R JACOBS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANNON LEIGH SMITH RN (OFFICE MANAGER)
(843) 797-6564
Entity
Organization
Contact information
Practice address
9213 UNIVERSITY BLVD STE D, NORTH CHARLESTON, SC 29406-9145
(843) 797-6564
(843) 572-9165
Mailing address
9213 UNIVERSITY BLVD STE D, NORTH CHARLESTON, SC 29406-9145
(843) 797-6564
(843) 572-9165
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
199702336
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113004
—
SC
01
—
1568535953
NPI- SINGLE PROVIDER
SC
01
—
C611963397
MEDICARE
SC
Enumeration date
04/22/2008
Last updated
04/22/2008
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