Individual provider · Type 1 NPI

Mitchell Wells Jacocks Jr.

Student in an Organized Health Care Education/Training Program · West Columbia, SC

NPI number 1669310090 Active

Practice location

145 Sunset Ct Ste 200
West Columbia, SC 29169-2464

Call (803) 314-9360 Map

Fax (803) 314-9361

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1669310090

Mitchell Wells Jacocks Jr.'s National Provider Identifier is 1669310090, issued on Mar 24, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in West Columbia, SC. The record was last updated on Mar 24, 2026.