J-Rapha Clinic LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

20233 Issued in SC

Legal business name

J-RAPHA CLINIC LLC

Practice address

1042 Professional Court
Manning, SC 29102-2827

Phone

(803) 433-7991

Fax

(803) 433-7791

NPI assigned

Jun 14, 2007

Last updated

May 6, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donatus M Egbonim, MD

Title

Owner

Phone

(803) 433-7991

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1487858163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1042 PROFESSIONAL COURT",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291022827",
            "telephone_number": "803-433-7991",
            "fax_number": "803-433-7791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1042 PROFESSIONAL COURT",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291022827",
            "telephone_number": "803-433-7991",
            "fax_number": "803-433-7791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J-RAPHA CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "EGBONIM",
        "authorized_official_first_name": "DONATUS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-433-7991",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "20233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT HEALTH FIRST CHOICE",
            "identifier": "20049632",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202337",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0116367",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00423235",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Hormann
• Megan Hovermale, RN
• Ramona J Howard, NP
• Kimberly Marie Hunt, O.D.
• Courtney Ives, BSN, RN, LNC
• Matthew Richard Jackson, DO
• Adri Johnson
• Kyndra Joy Johnson, LISW-CP
• Susanne P Johnson, FNP
• Cornelia Bradham Jones, APRN

• Internal Medicine Physician in Manning, SC
• Providers in Manning, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; 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.