Individual
JESSICA SMITH WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
102 GREGOR MENDEL CIR, GREENWOOD, SC 29646-2315
(864) 229-2663
(864) 223-5694
Mailing address
102 GREGOR MENDEL CIR, GREENWOOD, SC 29646-2315
(864) 229-2663
(864) 223-5694
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1082
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0687PA
—
SC
Enumeration date
11/13/2006
Last updated
12/14/2021
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