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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | Lane, Jordan Leigh | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| NPI | 1619224003 | [sources] | |||
| Sector | Ind-Lic Serv Prov - Physician Assistant | [sources] | |||
| Status | not available | [sources] | |||
| Address | Charleston, SC 29425 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers excluded from South Carolina's Medicaid program.
United States of America · SCDHHS
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States of America | South Carolina Department of Health and Human Services | - | |||