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Individual

CHARNELE VONTESE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DNP

Contact information

Practice address
1333 TAYLOR ST STE D, COLUMBIA, SC 29201-2923
(864) 455-2455
(864) 455-2450
Mailing address
300 E MCBEE AVE STE 300, GREENVILLE, SC 29601-2899
(864) 522-8603

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
25444
SC
207QA0505X
Adult Medicine Physician
542224
SC
363LF0000X
Family Nurse Practitioner
Primary
25444
SC

Other

Enumeration date
06/22/2021
Last updated
01/15/2026
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