Provider Demographics
NPI:1609213669
Name:PERRY, JENNIFER THREATT (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THREATT
Last Name:PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELAINE
Other - Last Name:THREATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1773 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1101
Mailing Address - Country:US
Mailing Address - Phone:033-280-1688
Mailing Address - Fax:803-325-8473
Practice Address - Street 1:1773 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1101
Practice Address - Country:US
Practice Address - Phone:803-328-0168
Practice Address - Fax:803-325-8473
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP02915207W00000X, 207R00000X
SC40959207W00000X
NC2017-00053207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine