Individual
JODIE MCCUTCHEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
137 N ACLINE ST, LAKE CITY, SC 29560-2107
(843) 394-8822
Mailing address
3507 CREEK RD, LAKE CITY, SC 29560-6624
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
44073
SC
Other
Enumeration date
05/14/2018
Last updated
05/14/2018
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