Individual
CHLOE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-1623
(843) 792-6200
Mailing address
PO BOX 751461, CHARLESTON, SC 29425-8908
(843) 792-1414
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4092
SC
363A00000X
Physician Assistant
9279
GA
363A00000X
Physician Assistant
—
—
Other
Enumeration date
04/24/2019
Last updated
01/20/2022
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