Provider Demographics
NPI:1871798660
Name:PRESSLY, JENNINGS G (MD)
Entity type:Individual
Prefix:DR
First Name:JENNINGS
Middle Name:G
Last Name:PRESSLY
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-0669
Mailing Address - Country:US
Mailing Address - Phone:864-228-2303
Mailing Address - Fax:864-228-3662
Practice Address - Street 1:110 HOSPITAL DR # B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3226
Practice Address - Country:US
Practice Address - Phone:864-228-0355
Practice Address - Fax:864-228-4827
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC74892085B0100X, 2085D0003X, 2085H0002X, 2085N0700X, 2085N0904X, 2085R0202X, 2085R0203X, 2085R0204X, 2085U0001X
NC196412085N0904X, 2085R0202X, 2085R0203X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085H0002XAllopathic & Osteopathic PhysiciansRadiologyHospice and Palliative Medicine
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1337UOtherBCBS NC
SC570919974OtherBCBS SC
NC891337UMedicaid
SC074895Medicaid
SCD47042Medicare UPIN
SC3755Medicare ID - Type Unspecified
SC074895Medicaid