Individual
MR. WILLIAM G JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
302 UNIVERSITY PKWY, AIKEN REGIONAL MEDICAL CENTER, AIKEN, SC 29801
(803) 641-5489
(803) 651-5148
Mailing address
1148 DAWN VIEW TERRACE, MT PLEASANT, SC 29464-4696
(843) 856-9960
(843) 856-9699
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN2614
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN0080
—
SC
Enumeration date
08/03/2006
Last updated
07/08/2007
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