Individual
SUSAN L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, MPH
Contact information
Practice address
2100 BULL ST, COLUMBIA, SC 29201-2104
(803) 898-1484
Mailing address
2100 BULL ST, COLUMBIA, SC 29201-2104
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
208337
SC
Other
Enumeration date
09/28/2015
Last updated
09/28/2015
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