Provider Demographics
NPI:1326068669
Name:HIGHSMITH, JASON M (MD)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:M
Last Name:HIGHSMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7301 RIVERS AVE STE 242
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4616
Mailing Address - Country:US
Mailing Address - Phone:843-510-0727
Mailing Address - Fax:843-474-0712
Practice Address - Street 1:7301 RIVERS AVE STE 242
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4616
Practice Address - Country:US
Practice Address - Phone:843-510-0727
Practice Address - Fax:843-474-0712
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057641207T00000X
SC29442207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC061102Medicaid
GA20208A001Medicare UPIN
I56770Medicare UPIN
AA18660281Medicare PIN