Individual
JONATHAN HAL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.S.
Contact information
Practice address
770 MEDICAL PARK DR, AIKEN, SC 29801-6307
(803) 649-3903
(803) 642-6161
Mailing address
367 S. GULPH RD, ATTN: IPM CREDENTIALING, KING OF PRUSSIA, PA 19406
(803) 716-8712
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
19933
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199332
—
SC
Enumeration date
12/16/2005
Last updated
03/07/2019
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