Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 36591 | SC |
NPI | 1518284843 |
---|---|
Provider Name | Dr. Gregory Ryan Jackson |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 25/06/2018 |