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General NPI Number Information
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NPI Number | 1063525525
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Entity Type | Organization
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Legal Business Name | JACKSON MED TECHS
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2080 DUNBARTON DR SUITE C
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City | JACKSON
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State | MS
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Zip | 39216-5016
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Country | US
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Telephone | 601-624-1318
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 320531
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City | FLOWOOD
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State | MS
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Zip | 39232-0531
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Country | US
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Telephone | 601-362-6898
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELTON A. DEAN JR.
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Credential |
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Telephone | 601-624-1318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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