# BAPTIST PT- LYMPHEDEMA CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053786996
- **Authorized official:** AMY GRISSETT (BILLING MANAGER)
- **Authorized official phone:** (601) 944-1717

## Contact information

- **Practice address:** 1225 N STATE ST, JACKSON, MS 39202-2064
- **Practice address phone:** (601) 974-6243
- **Mailing address:** 1225 N STATE ST, JACKSON, MS 39202-2064
- **Mailing address phone:** (601) 974-6243

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | MS | Yes |

## Other

- **Enumeration date:** 12/03/2015
- **Last updated:** 12/04/2015