Jackson, Lasandra D

Jackson, Lasandra D is an individual health care provider with primary practice located at 2755 S Highway 14 Suite 2200, Greer SC 29650-4902. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Jackson, Lasandra D can be contacted via phone (864) 849-9555.

Contact Information

Primary practice address
2755 S Highway 14 Suite 2200 Greer SC 29650-4902
Phone: (864) 849-9555
Fax: (864) 849-9556
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 0101240815 Virginia
Allopathic & Osteopathic Physicians / Surgery 208600000X 20289 South Carolina

Profile Details

NPI number 1356429674
LBN Legal business name Jackson, Lasandra D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2006
Last updated Jul 25th, 2019 - about 6 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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Identifiers

StateTypeNumberIssuer
All States NPI 1356429674 NPPES
South Carolina MEDICAID 202890
South Carolina Other C09633
South Carolina Other C06695

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