Provider Demographics
NPI:1578644704
Name:MOTLEY, JAROD ROSS (MD)
Entity type:Individual
Prefix:
First Name:JAROD
Middle Name:ROSS
Last Name:MOTLEY
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 1:16 MILLS AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4065
Mailing Address - Country:US
Mailing Address - Phone:864-735-8080
Mailing Address - Fax:
Practice Address - Street 1:16 MILLS AVE STE 6
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4065
Practice Address - Country:US
Practice Address - Phone:864-735-8080
Practice Address - Fax:800-889-1826
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29008207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC290081Medicaid
SCAA5115E178Medicare PIN