Individual
PORSHAI JUANICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6341 DERRYFIELD DR, CHARLOTTE, NC 28213-5532
(980) 230-8248
Mailing address
6341 DERRYFIELD DR, CHARLOTTE, NC 28213-5532
(980) 230-8248
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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