Individual
JERRY EWING SQUIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-0001
(843) 792-6200
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-1414
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
MD30197
SC
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
AL30197
SC
Other
Enumeration date
08/10/2007
Last updated
08/08/2024
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