Provider Demographics
NPI:1861066367
Name:ANDREWS, JACOB CHARLES (DO)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CHARLES
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER
Mailing Address - Street 2:14 MEDICAL PARK, STE 400
Mailing Address - City:COLUMBIA
Mailing Address - State:SD
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-6155
Mailing Address - Fax:803-434-6979
Practice Address - Street 1:600 BEVERLY HANKS CTR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2305
Practice Address - Country:US
Practice Address - Phone:828-693-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL83629208000000X
NC202401845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics