Provider Demographics
NPI:1619142841
Name:PICARD, JONATHAN CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CHRISTIAN
Last Name:PICARD
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 7927
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0927
Mailing Address - Country:US
Mailing Address - Phone:843-884-8045
Mailing Address - Fax:
Practice Address - Street 1:1122 CHUCK DAWLEY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4183
Practice Address - Country:US
Practice Address - Phone:843-884-8045
Practice Address - Fax:843-881-5081
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30650208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC306500Medicaid