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General NPI Number Information
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NPI Number | 1497930184
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERANS AFFAIR G.V. (SONNY) MONTGOMERY VA MEDICAL CENTE
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Dates
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Enumeration Date | 01/01/2008
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Last Update Date | 01/01/2008
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Provider Practice Location Address
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Address Line | 5942 WESTMORE DR
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City | JACKSON
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State | MS
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Zip | 39206-2209
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Country | US
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Telephone | 601-366-1739
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Fax |
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Provider Business Mailing Address
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Address Line | 5942 WESTMORE DR
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City | JACKSON
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State | MS
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Zip | 39206-2209
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Country | US
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Telephone | 601-366-1739
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Fax |
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Authorized Official
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Title or Position | NURSE RECRUITER
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Name | MRS. AMY WHEAT
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Credential | RN, BSN
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Telephone | 601-368-3873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | P321453
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License Number State | MS
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