Individual
DERRICK JAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RRT
Contact information
Practice address
14 DAVIS RD, RIDGE SPRING, SC 29129-9555
(803) 685-7508
Mailing address
14 DAVIS RD, RIDGE SPRING, SC 29129-9555
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
8468
GA
227900000X
Registered Respiratory Therapist
Primary
A-5442
NC
227900000X
Registered Respiratory Therapist
RCP4458
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8468
RESPIRATORY CARE PRACTITIONER
GA
01
—
A-5442
RESPIRATORY CARE PRACTITIONER
NC
01
—
RCP4458
RESPIRATORY CARE PRACTITIONER
SC
Enumeration date
05/20/2013
Last updated
05/20/2013
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