NPI 1689063067

St Dominic Medical Associates LLC

Organisation Urology Physician Jackson, MS

Practice location

Address: 971 Lakeland Dr Suite 360, Jackson, MS 39216-4643
Phone: (601) 200-4370
Fax: (601) 200-4375
Mailing address: PO Box 23666, Jackson, MS 39225-3666

Authorised official

Name: Jennifer Sinclair
Title: President of Sdma
Phone: (601) 200-6955

Registered specialties (3)

Urology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208800000X Licence 13524 (MS)

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Urology Physician

Allopathic & Osteopathic Physicians Taxonomy 208800000X Licence 11495 (MS)

Urology Physician

Allopathic & Osteopathic Physicians Taxonomy 208800000X Licence 09524 (MS)

Registry record

NPI: 1689063067
Entity type: Organization
NPI issued: 22 Jan 2015
Record last updated: 17 Jun 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.