Provider Demographics
NPI:1831570696
Name:FAIREY, JESSICA (MS, CGC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FAIREY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK RD STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6517
Practice Address - Country:US
Practice Address - Phone:803-545-5700
Practice Address - Fax:803-434-4699
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
16644OtherABGC