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General NPI Number Information
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NPI Number | 1316813868
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Entity Type | Organization
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Legal Business Name | CENTRAL MISSISSIPPI MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 2200 HIGHWAY 61 N STE 2100
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City | VICKSBURG
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State | MS
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Zip | 39183-8246
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Country | US
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Telephone | 601-955-3223
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 PETIT BOIS ST N
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City | JACKSON
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State | MS
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Zip | 39211-6707
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Country | US
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Telephone | 601-955-3223
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH WALKER BLACKSTON
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Credential |
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Telephone | 601-955-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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