Provider Demographics
NPI:1023166139
Name:LITTLE, JARROD ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:JARROD
Middle Name:ALEXANDER
Last Name:LITTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:206 BLUFFTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6213
Mailing Address - Country:US
Mailing Address - Phone:843-575-3308
Mailing Address - Fax:502-584-0302
Practice Address - Street 1:206 BLUFFTON RD STE 201
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6213
Practice Address - Country:US
Practice Address - Phone:843-575-3308
Practice Address - Fax:502-584-0302
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY413162086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50023218OtherPASSPORT
KY3704983000OtherPASSPORT ADVANTAGE
IN200942680Medicaid
KY64104862Medicaid
KY64104862Medicaid