Individual
JEREMY R. CRISP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
76 POLO RD, COLUMBIA, SC 29223-2806
(803) 699-7255
(803) 699-0848
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29768
SC
207Q00000X
Family Medicine Physician
LL29768
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297681
—
SC
01
—
AA53772353
MEDICARE PTAN
SC
Enumeration date
07/17/2007
Last updated
10/21/2020
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