NPI 1649604000

Jeffrey Walter Herndon

Practitioner Exclusive Provider Organization Walterboro, SC

Practice location

Address: 990 Academy Rd, Walterboro, SC 29488-9266
Phone: (843) 893-8122
Fax: (843) 549-2650

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 165834 (SC)

Other Exclusive Provider Organization providers in South Carolina →

Registry record

NPI: 1649604000
Entity type: Individual
Sex (as registered): Male
NPI issued: 21 Aug 2013
Record last updated: 21 Aug 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.