Individual
CHANELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
229 LONGTOWN RD, COLUMBIA, SC 29229-8550
(803) 419-4949
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 935-8292
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20603
SC
Other
Enumeration date
11/04/2016
Last updated
01/12/2024
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