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General NPI Number Information
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NPI Number | 1245754506
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Entity Type | Organization
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Legal Business Name | JACKSON LIVER AND GI SPECIALISTS INC.
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 971 LAKELAND DR STE 1159
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City | JACKSON
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State | MS
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Zip | 39216-4609
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Country | US
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Telephone | 769-251-5674
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Fax |
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Provider Business Mailing Address
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Address Line | 971 LAKELAND DR STE 1159
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City | JACKSON
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State | MS
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Zip | 39216-4609
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Country | US
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Telephone | 769-251-5674
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. BRIAN BORG
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Credential | MD MHSC
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Telephone | 769-251-5674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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