Individual
DR. BENJAMIN F JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
00026387
AL
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
31651
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009937031
—
AL
01
—
051534961
BCBS PROVIDER NUMBER
AL
Enumeration date
05/12/2006
Last updated
11/13/2020
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