MEDICARE: JACKSON IMAGING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471C3401X	Computed Tomography Radiologic Technologist

General Provider Information

NPI Number	:	1144370776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON IMAGING

Provider Business Mailing Address
First Line	:	1045 N FLOWOOD DR
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9533
Country	:	US
Telephone Number	:	601-936-0302
Fax Number	:	601-936-3416

Provider Business Practice Location Address
First Line	:	1045 N FLOWOOD DR
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9533
Country	:	US
Telephone Number	:	601-936-0302
Fax Number	:	601-936-3416

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. LYNNE R AMACKER
Credential	:
Telephone Number	:	601-936-0302

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

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Directions to “JACKSON IMAGING ” Practice Location

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