South Jackson Medical & Wellness Center LLC
Nurse Practitioner, Primary Care in Jackson, TN. Organization (NPI-2).
NPI number1295570083
StatusActive
Last updated in NPPESAug 16, 2024
Details
- NPI
- 1295570083
- Entity type
- Organization (NPI-2)
- Legal business name
- South Jackson Medical & Wellness Center LLC
- Organization subpart
- No
- Enumeration date
- Jun 25, 2024
- Certification date
- Aug 16, 2024
- Last updated
- Aug 16, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP2300X | Nurse Practitioner, Primary Care | – | – | Yes |
| 261QU0200X | Clinic/Center, Urgent Care | – | – |
Other names
- Primary Care South LLC (Former Legal Business Name)
- South Jackson Medical & Wellness Center (Doing Business As)
Practice location
1385 S Highland Ave Ste B1Jackson, TN 38301-7547
Phone 731-427-0470 · Fax 731-427-0995
Mailing address
Po Box 291Jackson, TN 38302-0291
Phone 731-427-0470
Authorized official
Maranda Haynes
Chief Compliance
7314270470
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