Provider Demographics
NPI:1558556258
Name:LUKOWSKI, JESSICA P (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:P
Last Name:LUKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:P
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2180
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-2180
Mailing Address - Country:US
Mailing Address - Phone:843-347-7216
Mailing Address - Fax:843-234-6990
Practice Address - Street 1:8004 MYRTLE TRACE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8945
Practice Address - Country:US
Practice Address - Phone:843-347-7216
Practice Address - Fax:843-347-7218
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33698207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC336988Medicaid
SCGP4505Medicaid
SC7844Medicare PIN
SCAA7264Medicare UPIN