Individual
DR. KIMBERLY SHELLEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
864 ISLAND PARK DR STE 101, DANIEL ISLAND, SC 29492-7446
(843) 876-7975
Mailing address
PO BOX 602108, CHARLOTTE, NC 28260-2108
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18009
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T19753
—
SC
Enumeration date
05/27/2006
Last updated
01/23/2019
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