Provider Demographics
NPI:1104116664
Name:WHITMIRE, JENNIFER C (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:WHITMIRE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-235-7665
Mailing Address - Fax:
Practice Address - Street 1:ST FRANCIS CARDIOVASCULAR
Practice Address - Street 2:317 ST. FRANCIS DR. STE 120
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3900
Practice Address - Country:US
Practice Address - Phone:864-255-1317
Practice Address - Fax:877-591-6931
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1639363AM0700X
SC1639363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3687PAMedicaid