Individual
JACK LEGRAND DEPRIEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 RICHLAND MEDICAL PARK DR STE 300, COLUMBIA, SC 29203-6831
(803) 545-5500
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
81661
SC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD065996L
PA
208M00000X
Hospitalist Physician
23454
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001699305
—
PA
05
—
816610
—
SC
Enumeration date
06/16/2005
Last updated
07/23/2024
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