Healthcare Provider Details

I. General information

NPI: 1356201693
Provider Name (Legal Business Name): JACKSON ONCOLOGY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BROAD ST
FOREST MS
39074-3508
US

IV. Provider business mailing address

1227 N STATE ST STE 101
JACKSON MS
39202-2002
US

V. Phone/Fax

Practice location:
  • Phone: 601-355-2485
  • Fax: 601-353-1463
Mailing address:
  • Phone: 601-974-5637
  • Fax: 601-974-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DENDY MAGEE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 601-974-5600