Healthcare Provider Details

I. General information

NPI: 1023355245
Provider Name (Legal Business Name): JACKSON MADISON GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JACKSON WALK PLAZA
JACKSON TN
38301
US

IV. Provider business mailing address

620 SKYLINE DR
JACKSON TN
38301-3923
US

V. Phone/Fax

Practice location:
  • Phone: 731-427-7048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: NICOLE HANCOCK
Title or Position: DIETITIAN
Credential:
Phone: 731-541-6564