Individual
DR. JACKSON MESSENGER CONDREY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
169 ASHLEY AVE, CHARLESTON, SC 29425-8905
(843) 792-2322
(843) 792-2314
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35878
SC
207L00000X
Anesthesiology Physician
LL35878
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL35878
LIMITED MEDICAL LICENSE NUMBER
SC
Enumeration date
06/18/2013
Last updated
07/21/2022
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