MEDICARE: JACKSON HEALTHCARE FOR WOMEN PA

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1902941768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON HEALTHCARE FOR WOMEN PA

Provider Business Mailing Address
First Line	:	1047 N FLOWOOD DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39232-9533
Country	:	US
Telephone Number	:	601-932-4185
Fax Number	:	601-982-0219

Provider Business Practice Location Address
First Line	:	1047 N FLOWOOD DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39232-9533
Country	:	US
Telephone Number	:	601-932-4185
Fax Number	:	601-982-0219

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN W COOK
Credential	:	MD
Telephone Number	:	601-936-9415

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

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