Individual
MRS. JILL M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
602 N MAIN ST, SUMMERVILLE, SC 29483-6627
(843) 876-2121
Mailing address
PO BOX 602108, CHARLOTTE, NC 28260-2108
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23562
SC
Other
Enumeration date
10/24/2006
Last updated
04/03/2014
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