Healthcare Provider Details

I. General information

NPI: 1013167444
Provider Name (Legal Business Name): JACKSON FAMILY MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 W FRANKLIN ST
JACKSON MI
49201-2008
US

IV. Provider business mailing address

724 W FRANKLIN ST
JACKSON MI
49201-2008
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-3100
  • Fax: 517-784-3200
Mailing address:
  • Phone: 517-784-3100
  • Fax: 517-784-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY LAVERNE LYND
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 517-784-3100