Individual
DR. KATHLEEN MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
701 GROVE RD FL 1, GREENVILLE, SC 29605-4210
(864) 455-7899
(864) 455-5474
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
84014
SC
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
84014
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/19/2017
Last updated
07/12/2023
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