Healthcare Provider Details

I. General information

NPI: 1780545103
Provider Name (Legal Business Name): J FAILS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11004 HIGHWAY 57 UNIT C
VANCLEAVE MS
39565-8278
US

IV. Provider business mailing address

PO BOX 684
LUCEDALE MS
39452-0684
US

V. Phone/Fax

Practice location:
  • Phone: 601-953-3433
  • Fax:
Mailing address:
  • Phone: 601-953-3433
  • Fax: 601-791-5243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER REDMOND
Title or Position: OWNER
Credential: NP-C
Phone: 601-953-3433