Healthcare Provider Details

I. General information

NPI: 1730550914
Provider Name (Legal Business Name): JACKSON HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CHADWICK DR
JACKSON MS
39204-3404
US

IV. Provider business mailing address

1850 CHADWICK DR
JACKSON MS
39204-3404
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-2561
  • Fax: 601-376-2570
Mailing address:
  • Phone: 601-376-2561
  • Fax: 601-376-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SWAW
Title or Position: DIRECTOR
Credential:
Phone: 615-778-8076