MEDICARE: LAUREN VICTORIA JACKSON

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	207P00000X	Emergency Medicine Physician	82328	SC

General Provider Information

NPI Number	:	1639524945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN VICTORIA JACKSON

Provider Business Mailing Address
First Line	:	PO BOX 421718
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29442-4203
Country	:	US
Telephone Number	:	843-527-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4070 HIGHWAY 17
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576
Country	:	US
Telephone Number	:	843-652-1000
Fax Number	:

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

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	12/03/2025

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