Provider Demographics
NPI:1215498753
Name:ZINK, JAMISON ALLAN
Entity type:Individual
Prefix:
First Name:JAMISON
Middle Name:ALLAN
Last Name:ZINK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 FAIRFOREST WAY APT 18101
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4679
Mailing Address - Country:US
Mailing Address - Phone:704-530-1457
Mailing Address - Fax:
Practice Address - Street 1:221 FAIRFOREST WAY APT 18101
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4679
Practice Address - Country:US
Practice Address - Phone:704-530-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD61402785207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program