Provider Demographics
NPI:1063647766
Name:SCOGGIN, JEFFREY M (CRNA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:SCOGGIN
Suffix:
Gender:
Credentials:CRNA
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Other - First Name:
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Mailing Address - Street 1:110 E MEDICAL LN STE 210B
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4817
Mailing Address - Country:US
Mailing Address - Phone:803-791-2491
Mailing Address - Fax:
Practice Address - Street 1:2720 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4810
Practice Address - Country:US
Practice Address - Phone:803-935-8538
Practice Address - Fax:803-791-2660
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC3907367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered