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Individual

JARRELL DUPREE NESMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O

Contact information

Practice address
2400 BOILING SPRINGS RD, BOILING SPRINGS, SC 29316-5304
(864) 599-0731
(864) 599-0791
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36729
SC
390200000X
Student in an Organized Health Care Education/Training Program
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
L36729
SC
05
PENDING
SC
01
SCA7316067
MEDICARE PIN
SC
01
SCA7316121
MEDICARE PIN
SC
01
SCA7317628
MEDICARE PIN
SC
01
SCA731J577
MEDICARE PIN
SC
Enumeration date
05/14/2014
Last updated
05/01/2023
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