Individual
ADRENNA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5110 FAIRFIELD RD, COLUMBIA, SC 29203-4323
(803) 893-7019
Mailing address
PO BOX 740013, ATLANTA, GA 30374-0013
(312) 733-9730
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
26151
SC
363LP2300X
Primary Care Nurse Practitioner
RN228470
GA
Other
Enumeration date
05/18/2022
Last updated
06/20/2024
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