Provider Demographics
NPI:1396974499
Name:HINSON, JESSICA CALHOUN (MA, ATC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CALHOUN
Last Name:HINSON
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:KRISTIN
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, ATC
Mailing Address - Street 1:454 WAGNER TRL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7036
Mailing Address - Country:US
Mailing Address - Phone:478-231-0396
Mailing Address - Fax:
Practice Address - Street 1:4801 HARD SCRABBLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9159
Practice Address - Country:US
Practice Address - Phone:803-699-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0009962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer