Active NPI
Jerry Hughes
- Community Health Worker
- Laurens, SC
National Provider Identifier
1396918694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 2731
- Practice address
- 379 Pinehaven St. Ext.
Suite 120
Laurens, SC 29360 - Phone
- (864) 832-6586
- NPI assigned
- Apr 8, 2008
- Last updated
- May 29, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 2731 | SC | Primary |
Addresses
Primary practice location
379 Pinehaven St. Ext.
Suite 120
Laurens, SC 29360
Mailing address
400 Grayson Dr
Moore, SC 29369-8910
Phone (864) 901-6554
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2731 | SC | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243555200000",
"number": "1396918694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 GRAYSON DR",
"city": "MOORE",
"state": "SC",
"postal_code": "293698910",
"telephone_number": "864-901-6554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "379 PINEHAVEN ST. EXT.",
"address_2": "SUITE 120",
"city": "LAURENS",
"state": "SC",
"postal_code": "29360",
"telephone_number": "864-832-6586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUGHES",
"first_name": "JERRY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-08",
"last_updated": "2009-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "SC",
"license": "2731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laurens, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.