Provider Demographics
NPI:1124289848
Name:JESUP, ALEXIS ANNE (MD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANNE
Last Name:JESUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:888-472-0043
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2270 ASHLEY CROSSING DR
Practice Address - Street 2:SUITE 170
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5732
Practice Address - Country:US
Practice Address - Phone:843-763-3700
Practice Address - Fax:843-606-8018
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2024-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC31111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC311111Medicaid