Healthcare Provider Details

I. General information

NPI: 1134820095
Provider Name (Legal Business Name): JIREH THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 RIVER THAMES PLACE
JACKSN MS
39211
US

IV. Provider business mailing address

5471 RIVER THAMES PLACE
JACKSN MS
39211
US

V. Phone/Fax

Practice location:
  • Phone: 601-566-5007
  • Fax:
Mailing address:
  • Phone: 601-566-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. KORLYNN TRICE
Title or Position: DIRECTOR OF BILLING
Credential: MHA
Phone: 601-624-5912