Healthcare Provider Details

I. General information

NPI: 1235058140
Provider Name (Legal Business Name): JONETTE ANN JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9313 MEDICAL PLAZA DR STE 101
NORTH CHARLESTON SC
29406-9802
US

IV. Provider business mailing address

147 BRITTONDALE RD
SUMMERVILLE SC
29485-7957
US

V. Phone/Fax

Practice location:
  • Phone: 843-847-3200
  • Fax: 843-847-4683
Mailing address:
  • Phone: 843-276-2581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: