Provider Demographics
NPI:1932172483
Name:JACKSON-DOZIER, FOCELL (MD)
Entity type:Individual
Prefix:
First Name:FOCELL
Middle Name:
Last Name:JACKSON-DOZIER
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-346-3900
Mailing Address - Fax:843-346-7839
Practice Address - Street 1:755 E SMITH ST
Practice Address - Street 2:
Practice Address - City:TIMMONSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29161-9430
Practice Address - Country:US
Practice Address - Phone:843-346-3900
Practice Address - Fax:843-346-7839
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT26834Medicaid
SCT26834Medicaid
SCG27652Medicare UPIN