Individual
MICHAEL LATRELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1156 BANNOCKBURN AVE, ROCK HILL, SC 29732-1095
(803) 718-5292
Mailing address
1156 BANNOCKBURN AVE, ROCK HILL, SC 29732-1095
(803) 718-5292
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
IHCP-2092
SC
Other
Enumeration date
03/25/2024
Last updated
05/20/2024
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