Male or Other

Aundra Jackson

Prosthetic/Orthotic Supplier in Columbia, SC(View on Map)

Full Name

Aundra Jackson

NPI Number

1518733278

NPI Type

Individual Provider

Gender

Male

Enumeration Date

12/04/2023

Specialties

(Taxonomies)

Code

335E00000X

Primary Taxonomy

Yes

Contact
Information

Purpose

Mailing
Location

Address

494 BLUE GARDEN WAY
494 BLUE GARDEN WAY

City

Columbia
Columbia

State

SC
SC

Postal Code

29223-8052
29223-8052

Country

US
US

Telephone Number

N/A
(803) 271-1462

Health Information Exchange

Endpoint Type

OTHERS

Endpoint

2676338881

Endpoint Description

Blue Garden Way

Use

Direct

Content Type

CSV

Affiliation

N

Endpoint Location

494 Blue Garden WayColumbia, SC292238052US

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 12/04/2023

Provider Address

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