Individual
LESLIE HODGES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
611 BECKMAN RD, COLUMBIA, SC 29203-3282
(803) 754-7783
Mailing address
611 BECKMAN RD, COLUMBIA, SC 29203-3282
(803) 754-7783
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
87674
SC
Other
Enumeration date
06/13/2007
Last updated
07/03/2014
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