Basic Information
| Provider Information | |||||||||
| NPI: | 1619934981 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEAUFORT JASPER HAMPTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 ELM STREET | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039432233 | ||||||||
| FaxNumber: | 8039430268 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 OKATIE HWY | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439877400 | ||||||||
| FaxNumber: | 8439877484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | DONALD | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 8039432233 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 22177 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.