Sophia Jackson
Home Health Aide in Simpsonville, SC. Individual provider (NPI-1).
NPI number1043710189
StatusActive
Last updated in NPPESFeb 15, 2018
Details
- NPI
- 1043710189
- Entity type
- Individual (NPI-1)
- Name
- Sophia Jackson
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Feb 15, 2018
- Last updated
- Feb 15, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 374U00000X | Home Health Aide | – | – | Yes |
Practice location
816 S Garrison RdSimpsonville, SC 29680-6818
Phone 864-356-4928
Mailing address
816 S Garrison RdSimpsonville, SC 29680-6818
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