Individual
LISA D JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
219A N MINE ST, MC CORMICK, SC 29835-8363
(864) 852-3336
(864) 852-3339
Mailing address
313 MAIN ST, SUITE B, GREENWOOD, SC 29646-2757
(864) 388-0301
(864) 388-0648
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
053559
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166197103A
—
GA
05
—
166197103B
—
GA
05
—
166197103C
—
GA
05
—
166197103D
—
GA
Enumeration date
08/25/2005
Last updated
09/18/2013
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