Individual
JEREMY THOMAS PONDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
147 VERA RD STE A, LEXINGTON, SC 29072-3756
(803) 575-0468
(803) 728-3224
Mailing address
736 SHADOWBROOK DR, COLUMBIA, SC 29210-3751
(803) 575-0468
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
638
SC
133V00000X
Registered Dietitian
Primary
L006090
NC
133VN1004X
Pediatric Nutrition Registered Dietitian
638
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20B5K
BCBS NC
NC
05
—
DT1055
—
SC
Enumeration date
03/03/2011
Last updated
02/22/2024
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