Individual
GEORGE MACK JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-7899
(864) 455-5474
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
32952
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
329521
—
SC
Enumeration date
08/21/2008
Last updated
07/21/2022
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