Individual
JACKIE EMMANUEL QUEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-7844
(864) 455-7848
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 797-6306
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
51169
SC
208000000X
Pediatrics Physician
51169
SC
Other
Enumeration date
06/13/2017
Last updated
07/21/2022
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