Individual
JEFFREY BETHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
410 N MAIN ST, MARION, SC 29571-3030
(843) 765-3212
Mailing address
410 N MAIN ST, MARION, SC 29571-3030
(843) 765-3212
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EX1183
—
SC
Enumeration date
05/01/2018
Last updated
05/01/2018
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