Individual
MISS SANDRA DENISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1150 BROAD ST STE 4, SUMTER, SC 29150-1997
(803) 869-1005
Mailing address
1150 BROAD ST, SUMTER, SC 29150-1997
(803) 566-3921
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
LI-234264
SC
Other
Enumeration date
05/14/2022
Last updated
05/14/2022
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