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General NPI Number Information
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NPI Number | 1851068324
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Entity Type | Organization
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Legal Business Name | JACKSON FREE CLINIC
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 925 MARTIN LUTHER KING JR DR
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City | JACKSON
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State | MS
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Zip | 39203-2233
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Country | US
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Telephone | 601-355-5161
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4892
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City | JACKSON
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State | MS
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Zip | 39296-4892
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Country | US
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Telephone | 601-355-5161
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Fax |
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Authorized Official
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Title or Position | CHAIR OF THE BOARD
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Name | HALI PETERSON
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Credential |
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Telephone | 601-355-5161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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