Provider Demographics
NPI:1073109971
Name:SMALLS, JANNIE
Entity Type:Individual
Prefix:
First Name:JANNIE
Middle Name:
Last Name:SMALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 VINEYARD POINT RD
Mailing Address - Street 2:
Mailing Address - City:ST HELENA IS
Mailing Address - State:SC
Mailing Address - Zip Code:29920-5721
Mailing Address - Country:US
Mailing Address - Phone:843-941-8500
Mailing Address - Fax:
Practice Address - Street 1:29 VINEYARD POINT RD
Practice Address - Street 2:
Practice Address - City:ST HELENA IS
Practice Address - State:SC
Practice Address - Zip Code:29920-5721
Practice Address - Country:US
Practice Address - Phone:843-941-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider