Individual
MR. JERRY SHADBOLT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1215 ALICE DR, SUMTER, SC 29150-1905
(803) 778-5223
Mailing address
3145 TAMARAH WAY, SUMTER, SC 29154-9556
(803) 778-5223
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
191
SC
Other
Enumeration date
08/29/2005
Last updated
07/08/2007
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