Provider Demographics
NPI:1255341947
Name:NORRIS, JEANETTE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:ELIZABETH
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:129 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4949
Practice Address - Country:US
Practice Address - Phone:803-774-9680
Practice Address - Fax:803-434-3955
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13727208000000X
SC37655208000000X, 208M00000X, 208000000X
TN36180208000000X
IL036122840208000000X, 208000000X
HI13492208000000X
FLME0060373208000000X
WA49290208000000X
CAG88825208000000X
MO2008030674208000000X
AZ44033208000000X
PAMD417957208000000X
NC2014-0061208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC376550Medicaid
IN000001577477OtherANTHEM
IN300036687Medicaid