Individual
MS. LISA CHANEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1264 RIBAUT RD STE 200, BEAUFORT, SC 29902-6127
(843) 524-2466
Mailing address
PO BOX 357, RIDGELAND, SC 29936-2605
(843) 987-7400
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
036113699
IL
207V00000X
Obstetrics & Gynecology Physician
Primary
33355
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113699
—
IL
Enumeration date
07/14/2006
Last updated
08/22/2024
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