Healthcare Provider Details

I. General information

NPI: 1891178315
Provider Name (Legal Business Name): JACKSON WOMEN'S HEALTH ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2903 N STATE ST
JACKSON MS
39216-4202
US

IV. Provider business mailing address

2903 N STATE ST
JACKSON MS
39216-4202
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-2261
  • Fax: 601-362-5973
Mailing address:
  • Phone: 601-366-2261
  • Fax: 601-362-5973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number005
License Number StateMS

VIII. Authorized Official

Name: SHANNON BREWER
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 601-366-2261