Provider Demographics
NPI:1134332547
Name:GAIL JENNINGS
Entity type:Organization
Organization Name:GAIL JENNINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-808-0438
Mailing Address - Street 1:308 LOUISE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7327
Mailing Address - Country:US
Mailing Address - Phone:803-808-0438
Mailing Address - Fax:803-808-7598
Practice Address - Street 1:308 LOUISE CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7327
Practice Address - Country:US
Practice Address - Phone:803-808-0438
Practice Address - Fax:803-808-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX4238Medicaid