Lisa D Jennings, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

053559 Issued in GA

Practice address

219A N Mine St
MC Cormick, SC 29835-8363

Phone

(864) 852-3336

Fax

(864) 852-3339

NPI assigned

Aug 25, 2005

Last updated

Sep 18, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carolina Health Centers, Inc.

  dba McCormick Family Practice

  • Family Medicine Physician
  • McCormick, SC
  • NPI 1063545119
  NPD (past)
• Carolina Health Centers, Inc.

  dba Carolina Health Centers at Newberry MHC

  • Federally Qualified Health Center (FQHC)
  • Newberry, SC
  • NPI 1669166054

  Family Medicine

  NPD (past)
• Carolina Health Centers, Inc.

  dba Calhoun Falls Family Practice

  • Federally Qualified Health Center (FQHC)
  • Calhoun Falls, SC
  • NPI 1871626259

  Family Medicine

  NPD (past)
• Tri-County Health System, Inc.

  • Federally Qualified Health Center (FQHC)
  • Crawfordville, GA
  • NPI 1124294434
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1255324190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 MAIN ST",
            "address_2": "SUITE B",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462757",
            "telephone_number": "864-388-0301",
            "fax_number": "864-388-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219A N MINE ST",
            "city": "MC CORMICK",
            "state": "SC",
            "postal_code": "298358363",
            "telephone_number": "864-852-3336",
            "fax_number": "864-852-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "LISA",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-25",
        "last_updated": "2013-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "053559",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166197103B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166197103C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166197103D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166197103A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alston Hargrove
• Healthstat on-Site Clinic/Milliken McCormick
• Healthstat Onsite Clinic MVM McCormick
• Healthstat Onsite Clinic Riegel McCormick
• Katherine Hudson, PT, DPT
• John de la Howe School
• Monty Kitchens, PA-C
• Robert Jay Lagroon, DMD
• Haley Landry
• Gregory T Lang, M.D.

• Family Medicine Physician in McCormick, SC
• Providers in McCormick, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.