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General NPI Number Information
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NPI Number | 1073237350
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Entity Type | Individual
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Provider Name | MS. CELIA ANDERSON JACKSON
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Gender | Female
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 2441 ATLAS ROAD
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City | COLUMBIA
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State | SC
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Zip | 29209-9744
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Country | US
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Telephone | 404-803-3805
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Fax |
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Provider Business Mailing Address
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Address Line | 127 LATEESHA RD
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City | HOPKINS
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State | SC
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Zip | 29061-9744
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Country | US
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Telephone | 803-875-1896
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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