Individual
DR. LAURA B JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7037 ST ANDREWS ROAD, COLUMBIA, SC 29212-1177
(803) 732-0963
(803) 732-1406
Mailing address
PO BOX 6069, CHARLOTTE, NC 28289-6239
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23898
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
238987
—
SC
Enumeration date
08/03/2006
Last updated
11/06/2020
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