Provider Demographics
NPI:1821250077
Name:SNIPES, JONATHAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:SNIPES
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:SNIPES MEDICAL SERVICES
Mailing Address - Street 2:#1053 78 FOLLY ROAD STE B9
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6522
Mailing Address - Country:US
Mailing Address - Phone:800-835-2362
Mailing Address - Fax:864-877-1260
Practice Address - Street 1:SNIPES MEDICAL SERVICES
Practice Address - Street 2:#1053 78 FOLLY ROAD STE B9
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-2940
Practice Address - Country:US
Practice Address - Phone:800-835-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36.1547532084P0800X
VT42.00164742084P0800X
FLME1587072084P0800X
SC309312084P0800X
GA660792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC309311Medicaid