Individual
DR. ALLEN B JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8761 DORCHESTER RD STE 100, NORTH CHARLESTON, SC 29420-7320
(843) 767-3323
(843) 767-4252
Mailing address
PO BOX 13955, CHARLESTON, SC 29422-3955
(843) 764-0770
(843) 863-0402
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13680
SC
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
13680
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136800
—
SC
05
—
GP6738
—
SC
Enumeration date
03/24/2006
Last updated
11/03/2023
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