Provider Demographics
NPI:1366448771
Name:FLEMING, JOHN RUSSELL JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUSSELL
Last Name:FLEMING
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1035 FOXRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1732
Mailing Address - Country:US
Mailing Address - Phone:803-236-9180
Mailing Address - Fax:
Practice Address - Street 1:1229 ALICE DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1970
Practice Address - Country:US
Practice Address - Phone:803-905-2273
Practice Address - Fax:803-905-7775
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20821207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT49196Medicaid
SCG306139326Medicare PIN
SCT49196Medicaid
SCG306137436Medicare PIN