Provider Demographics
NPI:1003103730
Name:GANDY, JASON LERAND (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LERAND
Last Name:GANDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 DREHER SHOALS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7608
Mailing Address - Country:US
Mailing Address - Phone:803-216-1223
Mailing Address - Fax:800-878-0910
Practice Address - Street 1:3543 DREHER SHOALS RD STE 1
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7608
Practice Address - Country:US
Practice Address - Phone:803-216-1223
Practice Address - Fax:800-878-0910
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL337762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry