Back, Jerry G

Back, Jerry G is an individual health care provider with primary practice located at 2845 Tricom St , North Charleston SC 29406-9172. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Back, Jerry G can be contacted via phone (843) 863-8100.

Contact Information

Primary practice address
2845 Tricom St North Charleston SC 29406-9172
Phone: (843) 863-8100
Fax: (843) 553-2122
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 30658 South Carolina

Profile Details

NPI number 1821181868
LBN Legal business name Back, Jerry G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 2nd, 2006
Last updated Jan 14th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821181868 NPPES
Colorado Other C495158 MEDICARE GROUP NUMBER

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