# CENTRAL JACKSON FAMILY MEDICAL CLINIC

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

## Provider details

- **NPI number:** 1154549707
- **Authorized official:** DR. CASSANDRA FAYE THOMAS M.D. (PHYSICAIN)
- **Authorized official phone:** (601) 981-7198

## Contact information

- **Practice address:** 514 C WOODROW WILSON, JACKSON, MS 39216
- **Practice address phone:** (601) 981-7198
- **Practice address fax:** (601) 981-6616
- **Mailing address:** P.O. BOX 4610, JACKSON, MS 39296-4610
- **Mailing address phone:** (601) 981-7198
- **Mailing address fax:** (601) 981-6616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 13653 | MS | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | 18905 | MS | — |

## Other

- **Enumeration date:** 04/20/2007
- **Last updated:** 12/09/2010