Provider Demographics
NPI:1073237350
Name:ANDERSON JACKSON, CELIA
Entity type:Individual
Prefix:MS
First Name:CELIA
Middle Name:
Last Name:ANDERSON JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 LATEESHA RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-9744
Mailing Address - Country:US
Mailing Address - Phone:803-875-1896
Mailing Address - Fax:
Practice Address - Street 1:2441 ATLAS ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-9744
Practice Address - Country:US
Practice Address - Phone:404-803-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No172V00000XOther Service ProvidersCommunity Health Worker
No251E00000XAgenciesHome Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide