Individual
DR. JASON JOHN STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3209 COLONIAL DR, COLUMBIA, SC 29203-6930
(803) 434-6113
(803) 434-7231
Mailing address
3209 COLONIAL DR, COLUMBIA, SC 29203-6930
(803) 434-6116
(803) 434-7529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24051
SC
207QS0010X
Sports Medicine (Family Medicine) Physician
24051
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0534520001
MEDICARE DME
SC
05
—
240518
—
SC
Enumeration date
02/20/2006
Last updated
04/02/2010
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