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Individual

JACKEYA WHITTEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
560 EUTAW HWY, EUTAWVILLE, SC 29048-9037
(803) 825-2226
(803) 492-3482
Mailing address
560 EUTAW HWY, EUTAWVILLE, SC 29048-9037
(803) 825-2226
(803) 492-3482

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
011710052
SC

Other

Enumeration date
09/25/2018
Last updated
09/25/2018
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