Provider Demographics
NPI:1992339220
Name:DONALD JASON JOLLEY
Entity type:Organization
Organization Name:DONALD JASON JOLLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:JOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-574-4470
Mailing Address - Street 1:2306 CHESNEE HWY
Mailing Address - Street 2:SUITE #6
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-5507
Mailing Address - Country:US
Mailing Address - Phone:864-574-4470
Mailing Address - Fax:864-575-3739
Practice Address - Street 1:2306 CHESNEE HWY
Practice Address - Street 2:SUITE #6
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-5507
Practice Address - Country:US
Practice Address - Phone:864-574-4470
Practice Address - Fax:864-575-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies