Individual
JEREMY R MCCALLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3980 HIGHWAY 9 E STE 200, LITTLE RIVER, SC 29566-8164
(843) 390-0100
(843) 390-0038
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 390-0100
(843) 390-0038
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
82208
SC
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
82208
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
822088
—
SC
Enumeration date
06/17/2010
Last updated
02/22/2021
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