Provider Demographics
NPI:1750737177
Name:USAAJJ MEDICAL LLC
Entity type:Organization
Organization Name:USAAJJ MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANYIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-731-2162
Mailing Address - Street 1:1523 HERITAGE LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3197
Mailing Address - Country:US
Mailing Address - Phone:843-731-2162
Mailing Address - Fax:
Practice Address - Street 1:1523 HERITAGE LN UNIT B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3197
Practice Address - Country:US
Practice Address - Phone:843-731-2162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty