Provider Demographics
NPI:1235109117
Name:EMERY, JACQUELINE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANN
Last Name:EMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:EMERY
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:1 SCIENCE CT
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9344
Practice Address - Country:US
Practice Address - Phone:803-252-1913
Practice Address - Fax:803-252-2330
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19729174400000X
NC9701333174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01333Medicaid
SCG300247361Medicare PIN
SC220032403Medicare PIN
SCN01333Medicaid