Healthcare Provider Details

I. General information

NPI: 1487179156
Provider Name (Legal Business Name): PATHWAY HEALTHCARE - JACKSON, MS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 450
JACKSON MS
39202-2000
US

IV. Provider business mailing address

1000 URBAN CENTER DR STE 600
VESTAVIA AL
35242-2584
US

V. Phone/Fax

Practice location:
  • Phone: 205-208-9312
  • Fax:
Mailing address:
  • Phone: 205-208-9312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW TURNER
Title or Position: PRESIDENT
Credential:
Phone: 205-208-9312