Individual
DR. CLINTONIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5 MEMORIAL MEDICAL CT, GREENVILLE, SC 29605-4449
(864) 272-3409
Mailing address
3620 PELHAM RD, PMB 145, GREENVILLE, SC 29615-5044
(321) 698-7637
(307) 316-0409
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME66277
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000042300
—
FL
Enumeration date
12/18/2006
Last updated
08/23/2016
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