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General NPI Number Information
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NPI Number | 1639059314
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Entity Type | Organization
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Legal Business Name | LAKELAND MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 140 DAUGHDRILL STA
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City | FLOWOOD
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State | MS
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Zip | 39232-8406
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Country | US
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Telephone | 601-965-9400
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Fax | 601-965-9418
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Provider Business Mailing Address
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Address Line | 140 DAUGHDRILL STA
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City | FLOWOOD
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State | MS
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Zip | 39232-8406
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Country | US
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Telephone | 601-965-9400
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Fax | 601-965-9418
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Authorized Official
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Title or Position | COO/OFFICE MANAGER
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Name | JACKIE THOMPSON
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Credential |
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Telephone | 601-672-7352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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