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General NPI Number Information
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NPI Number | 1780545103
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Entity Type | Organization
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Legal Business Name | J FAILS, LLC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 11004 HIGHWAY 57 UNIT C
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City | VANCLEAVE
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State | MS
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Zip | 39565-8278
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Country | US
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Telephone | 601-953-3433
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 684
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City | LUCEDALE
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State | MS
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Zip | 39452-0684
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Country | US
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Telephone | 601-953-3433
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Fax | 601-791-5243
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER REDMOND
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Credential | NP-C
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Telephone | 601-953-3433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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