Basic Information
| Provider Information | |||||||||
| NPI: | 1821250077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNIPES | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | SNIPES MEDICAL SERVICES | ||||||||
| Address2: | #1053 78 FOLLY ROAD STE B9 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294076522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008352362 | ||||||||
| FaxNumber: | 8648771260 | ||||||||
| Practice Location | |||||||||
| Address1: | SNIPES MEDICAL SERVICES | ||||||||
| Address2: | #1053 78 FOLLY ROAD STE B9 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294072940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008352362 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 30931 | SC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 309311 | 05 | SC | MEDICAID |