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Individual

PORTIA GOODE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
887 PINE LOG FORD RD, TRAVELERS REST, SC 29690-8418
(803) 467-8687
Mailing address
887 PINE LOG FORD RD, TRAVELERS REST, SC 29690-8418
(803) 467-8687

Taxonomy

Speciality
Code
Description
License number
State
342000000X
Transportation Network Company
Primary
01328980
SC

Other

Enumeration date
07/26/2023
Last updated
07/26/2023
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