Individual
DEWANDA JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1167 BINNICKER BRIDGE RD, COPE, SC 29038-9393
(347) 456-0926
Mailing address
1167 BINNICKER BRIDGE RD, COPE, SC 29038-9393
(347) 456-0926
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
01147927
SC
Other
Enumeration date
09/19/2025
Last updated
09/19/2025
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