Individual
LANIER B JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
33956
SC
208000000X
Pediatrics Physician
33956
SC
2080P0202X
Pediatric Cardiology Physician
33956
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
VA
Other
Enumeration date
06/02/2008
Last updated
02/18/2022
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