Healthcare Provider Details

I. General information

NPI: 1780692400
Provider Name (Legal Business Name): JACKSON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 LANSING AVE
JACKSON MI
49202-2193
US

IV. Provider business mailing address

1715 LANSING AVE
JACKSON MI
49202-2193
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-4420
  • Fax: 517-788-4373
Mailing address:
  • Phone: 517-788-4420
  • Fax: 517-788-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. RASHMI TRAVIS
Title or Position: HEALTH OFFICER
Credential:
Phone: 517-768-1658