# ST. DOMINIC MEDICAL ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST. DOMINIC JACKSON MEMORIAL HOSPITAL
- **Other names:** Internal Medicine Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1124252788
- **Legal business name:** ST. DOMINIC JACKSON MEMORIAL HOSPITAL
- **Authorized official:** DANIELLE STUART (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (601) 200-4880

## Contact information

- **Practice address:** 971 LAKELAND DR, SUITE 250, JACKSON, MS 39216-4643
- **Practice address phone:** (601) 982-1283
- **Mailing address:** PO BOX 23666, JACKSON, MS 39225-3666
- **Mailing address phone:** (601) 200-5986

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | MS | Yes |

## Other

- **Enumeration date:** 05/12/2009
- **Last updated:** 07/22/2019