Provider Demographics
NPI:1952382277
Name:HEGLER, JONATHAN H
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:H
Last Name:HEGLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3860
Mailing Address - Country:US
Mailing Address - Phone:864-725-4272
Mailing Address - Fax:864-725-4452
Practice Address - Street 1:1325 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3860
Practice Address - Country:US
Practice Address - Phone:864-725-4272
Practice Address - Fax:864-725-4452
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL34283Medicaid
SC198461OtherMEDCOST PIN
H26345Medicare UPIN
SCL34283Medicaid
H263456286Medicare PIN
SCH263451127Medicare PIN