Provider Demographics
NPI:1295727717
Name:JETER, NATASHIA A (MD)
Entity type:Individual
Prefix:
First Name:NATASHIA
Middle Name:A
Last Name:JETER
Suffix:
Gender:F
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:319 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379
Practice Address - Country:US
Practice Address - Phone:864-427-8380
Practice Address - Fax:864-427-8308
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500632207V00000X
SC26475207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA8066H918OtherMEDICARE PIN
SCP01577394OtherRAILROAD MEDICARE
SCAA80663365OtherMEDICARE PIN
SC264751Medicaid
NC5900750Medicaid
SCAA80666162OtherMEDICARE PIN
SCAA80663365Medicare PIN