Individual
AUNDRA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
494 BLUE GARDEN WAY, COLUMBIA, SC 29223-8052
(803) 271-1462
(267) 633-8881
Mailing address
494 BLUE GARDEN WAY, COLUMBIA, SC 29223-8052
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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