Provider Demographics
NPI:1902000912
Name:HODGES JACKSON, LESLIE (RN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HODGES JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 BECKMAN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-3282
Mailing Address - Country:US
Mailing Address - Phone:803-754-7783
Mailing Address - Fax:
Practice Address - Street 1:611 BECKMAN RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-3282
Practice Address - Country:US
Practice Address - Phone:803-754-7783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87674163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse