Individual
MARIAH KAY JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
169 ASHLEY AVE, CHARLESTON, SC 29425-4607
(843) 792-1414
Mailing address
140 BLACKBURN RD W, IRMO, SC 29063-8925
(304) 840-9030
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3100
SC
Other
Enumeration date
12/11/2018
Last updated
05/18/2025
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