Provider Demographics
NPI:1467560003
Name:AYA-AY, JEROME BENITEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:BENITEZ
Last Name:AYA-AY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:8311 WARREN H ABERNATHY HWY
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1249
Practice Address - Country:US
Practice Address - Phone:864-562-5100
Practice Address - Fax:864-562-5230
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC272109Medicaid
SC272109Medicaid