Provider Demographics
NPI:1386871655
Name:JAMISON, JENNIFER GRIER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GRIER
Last Name:JAMISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:1409 W GEORGIA RD
Practice Address - Street 2:SUITE B
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6419
Practice Address - Country:US
Practice Address - Phone:864-454-5000
Practice Address - Fax:864-454-5005
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10033766390200000X
TXP2011207Q00000X
SC35412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC354128Medicaid
SCSC10387951Medicare PIN