# LANIER B JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1982862389
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | 33956 | SC | Yes |
| 208000000X | Pediatrics Physician | 33956 | SC | — |
| 2080P0202X | Pediatric Cardiology Physician | 33956 | SC | — |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | VA | — |

## Other

- **Enumeration date:** 06/02/2008
- **Last updated:** 02/18/2022