Individual
EMMA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
105 N MAGNOLIA ST, SUMTER, SC 29150-4941
(803) 773-5511
Mailing address
5615 FAMILY LN, REMBERT, SC 29128-9166
(240) 441-2797
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R155044
MD
Other
Enumeration date
04/29/2020
Last updated
04/29/2020
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