Provider Demographics
NPI:1063413136
Name:JEWELL, JAMES LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:JEWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1218 AUBURNDALE LN
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9600
Mailing Address - Country:US
Mailing Address - Phone:803-366-4818
Mailing Address - Fax:803-366-4818
Practice Address - Street 1:1147 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2355
Practice Address - Country:US
Practice Address - Phone:803-329-6648
Practice Address - Fax:803-985-4134
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC12269207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC122691/GP2323Medicaid
SC122691/GP2323Medicaid
SC7225Medicare ID - Type Unspecified