Healthcare Provider Details

I. General information

NPI: 1780192690
Provider Name (Legal Business Name): JACKSON ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N STATE ST STE 101
JACKSON MS
39202-2002
US

IV. Provider business mailing address

1227 N STATE ST STE 101
JACKSON MS
39202-2002
US

V. Phone/Fax

Practice location:
  • Phone: 601-355-2485
  • Fax: 601-353-1463
Mailing address:
  • Phone: 601-355-2485
  • Fax: 601-353-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateMS

VIII. Authorized Official

Name: RICHARD W GRIFFITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-974-5578