Healthcare Provider Details

I. General information

NPI: 1043315906
Provider Name (Legal Business Name): EMERGENCY MEDICINE ASSOCIATES OF JACKSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

PO BOX 16076
JACKSON MS
39236-6076
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-6001
  • Fax: 601-936-4389
Mailing address:
  • Phone: 601-936-6001
  • Fax: 601-936-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC ZOOG
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 601-936-6001