Individual
JENNIFER BAILEY NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4278 LADSON RD, LADSON, SC 29456-5452
(843) 203-2240
(843) 203-2241
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1022
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010222
—
SC
01
—
P00638306
RAILROAD MEDICARE
SC
01
—
P00784094
RAILROAD MEDICARE-EFF 5/1/2009
SC
Enumeration date
07/25/2006
Last updated
01/25/2021
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