NPI 1366991523

Jackson State University

Organisation General Practice Physician Jackson, MS

Practice location

Address: 1400 Jr Lynch St, Jackson, MS 39217-0002
Phone: (601) 979-2291
Mailing address: 5050 Spring Valley Rd, Dallas, TX 75244-3995

Authorised official

Name: Mouzon Bass
Title: Agent
Phone: (972) 367-4845

Registered specialties

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence 09707 (MS)

Other General Practice providers in Mississippi →

Registry record

NPI: 1366991523
Entity type: Organization
NPI issued: 29 Sep 2016
Record last updated: 29 Sep 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.