| Doctor Name: | DR. THEODOLPH HAMILTON JACOBS |
| NPI Number: | 1912906975 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | SC10529 |
| Business Practice Address: | 2317 Ashley River Rd Charleston, SC - 294144753 |
| Business Phone Number: | 8435569591 |
| Business Fax Number: | 8435564651 |
| Mailing Address: | 2317 Ashley River Rd, CHARLESTON |
| State: | SC |
| Postal Code: | 294144753 |
| Phone Number: | 8435569591 |
| Fax Number: | 8435564651 |
| NPI Enumeration Date: | 07/20/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | SC10529 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |