Individual
JEFFERY DAVID HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3455 CRESTVIEW RD, DALZELL, SC 29040-9323
(803) 236-7465
Mailing address
3455 CRESTVIEW RD, DALZELL, SC 29040-9323
(803) 236-7465
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
CA014071
SC
Other
Enumeration date
01/16/2024
Last updated
01/16/2024
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