MEDICARE: DR. ALLISON GIDDINGS JACKSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	141246	NC
2	207V00000X	Obstetrics & Gynecology Physician	34054	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA81523922	OTHER	SC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194929588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON GIDDINGS JACKSON M.D.

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-522-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 HALTON VILLAGE CIR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-6825
Country	:	US
Telephone Number	:	864-455-1600
Fax Number	:	864-286-5298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	06/28/2021

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