Provider Demographics
NPI:1407267263
Name:NESMITH, JARRELL DUPREE (DO)
Entity Type:Individual
Prefix:
First Name:JARRELL
Middle Name:DUPREE
Last Name:NESMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5304
Practice Address - Country:US
Practice Address - Phone:864-599-0731
Practice Address - Fax:864-599-0791
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36729207Q00000X
SC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL36729Medicaid
SCPENDINGMedicaid
SCSCA7316121OtherMEDICARE PIN
SCSCA7317628OtherMEDICARE PIN
SCSCA731J577OtherMEDICARE PIN
SCSCA7316067OtherMEDICARE PIN