Jackson, Larry Randolph

Jackson, Larry Randolph is an sole proprietor health care provider with primary practice located at 615 Rapids Rd , Columbia SC 29212-3024. He recently has only one registered license in Nursing Service Providers / Psychiatric/Mental Health, which is considered as his primary health care specialty. Jackson, Larry Randolph can be contacted via phone (803) 798-2211.

Contact Information

Primary practice address
615 Rapids Rd Columbia SC 29212-3024
Phone: (803) 798-2211
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Psychiatric/Mental Health 163WP0808X 56879 South Carolina

Profile Details

NPI number 1093878191
LBN Legal business name Jackson, Larry Randolph
Credentials REGISTERED NURSE
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 19th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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