Individual
LASANDRA D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2755 S HIGHWAY 14, SUITE 2200, GREER, SC 29650-4902
(864) 849-9555
(864) 849-9556
Mailing address
PO BOX 419402, BOSTON, MA 02241-9402
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101240815
VA
208600000X
Surgery Physician
20289
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202890
—
SC
01
—
C06695
GROUP PTAN
VA
01
—
C09633
GROUP PTAN
VA
Enumeration date
11/02/2006
Last updated
01/21/2025
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