MEDICARE: JACKSON CARDIOLOGY ASSOCIATES, P.A.

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1851305429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON CARDIOLOGY ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	971 LAKELAND DR., STE 850
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4609
Country	:	US
Telephone Number	:	601-981-8543
Fax Number	:

Provider Business Practice Location Address
First Line	:	971 LAKELAND DR STE 850
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4608
Country	:	US
Telephone Number	:	601-981-8543
Fax Number	:

Authorized Official
Title or Position	:	CODING SPECIALIST
Name	:	JAYNE HANNAH
Credential	:
Telephone Number	:	601-364-5478

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	02/10/2010

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