Individual
DR. JANICE LYNNE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
222 E MEDICAL LN STE 300, WEST COLUMBIA, SC 29169-4848
(803) 936-8100
(803) 936-8130
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
10128
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101286
—
SC
Enumeration date
04/12/2006
Last updated
10/13/2020
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