Provider Demographics
NPI:1568541977
Name:JERNIGAN, FRITZ MORGAN (LMBT)
Entity Type:Individual
Prefix:
First Name:FRITZ
Middle Name:MORGAN
Last Name:JERNIGAN
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5927
Mailing Address - Country:US
Mailing Address - Phone:864-320-7842
Mailing Address - Fax:
Practice Address - Street 1:16 E LEWIS PLZ
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-2942
Practice Address - Country:US
Practice Address - Phone:864-370-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3437225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist