Individual
AIDA JACIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1023 CREEKSIDE MEDICAL DR, YORK, SC 29745-8624
(803) 684-3738
(803) 684-3808
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(803) 684-3738
(803) 684-3808
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29287
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292873
—
SC
05
—
5915465
—
NC
Enumeration date
10/10/2006
Last updated
02/15/2013
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