Individual
JACKSON DEREK HARTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
876 W FARIS RD, GREENVILLE, SC 29605-4253
(864) 455-5648
Mailing address
876 W FARIS RD, GREENVILLE, SC 29605-4253
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
LL92431
SC
Other
Enumeration date
03/28/2024
Last updated
08/09/2024
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