Provider Demographics
NPI:1942256201
Name:LOKEY, JONATHAN SULLIVAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SULLIVAN
Last Name:LOKEY
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 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE B260
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-454-2100
Practice Address - Fax:864-454-1201
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17297208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863077OtherBCBS OF SC
SC5402665OtherAETNA
SC8813430OtherCIGNA
SCP00801286OtherRR MEDICARE
SC172976Medicaid
SC576007863093OtherBLUE CHOICE OF SC
SC20047660OtherRR MEDICARE
SC576007863093OtherBLUE CHOICE OF SC
SC20047660OtherRR MEDICARE
SCG724696904Medicare PIN