Individual
CHARLES STEVEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10630 CLEMSON BLVD, STE 100, SENECA, SC 29678-4546
(864) 482-6000
(864) 482-7166
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 797-6306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
377
SC
363AS0400X
Surgical Physician Assistant
377
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0041PA
—
SC
05
—
2217PA
—
SC
01
—
990013229
RR MEDICARE
SC
Enumeration date
03/24/2006
Last updated
05/11/2021
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