Individual
DR. MARK R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 SAINT FRANCIS DR, SUITE 330, GREENVILLE, SC 29601-3971
(864) 255-1834
(864) 255-1836
Mailing address
3 SAINT FRANCIS DR, SUITE 330, GREENVILLE, SC 29601-3971
(864) 255-1834
(864) 255-1836
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
23559
SC
2086S0129X
Vascular Surgery Physician
Primary
23559
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89067KH
—
NC
05
—
T78966
—
SC
Enumeration date
05/03/2006
Last updated
11/06/2020
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