Provider Demographics
NPI:1871072827
Name:AMNESTY HEALTH GROUP LLC
Entity type:Organization
Organization Name:AMNESTY HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-464-7986
Mailing Address - Street 1:1650 SKYLYN DR STE 420
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1047
Mailing Address - Country:US
Mailing Address - Phone:864-464-7985
Mailing Address - Fax:864-203-1301
Practice Address - Street 1:3227 SUNSET BLVD STE C
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3201
Practice Address - Country:US
Practice Address - Phone:803-973-0299
Practice Address - Fax:803-973-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty