Provider Demographics
NPI:1134499296
Name:SOUTH, JACOB A (GENETIC COUNSELOR)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:A
Last Name:SOUTH
Suffix:
Gender:M
Credentials:GENETIC COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CANDLER DR STE 204
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6092
Mailing Address - Country:US
Mailing Address - Phone:912-819-5749
Mailing Address - Fax:
Practice Address - Street 1:225 CANDLER DR STE 204
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6092
Practice Address - Country:US
Practice Address - Phone:912-819-5749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1134499296OtherNPI