# MEDICAL MALL HEALTH SERVICES OF MISSISSIPPI, LLC

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

## Provider details

- **NPI number:** 1194083139
- **Authorized official:** MR. TIMOTHY P MCNEIL RN (COO)
- **Authorized official phone:** (202) 344-5465

## Contact information

- **Practice address:** 350 W WOODROW WILSON AVE, SUITE 499A, JACKSON, MS 39213-7681
- **Practice address phone:** (601) 700-7709
- **Practice address fax:** (877) 852-6352
- **Mailing address:** 350 W WOODROW WILSON AVE., SUITE 499A, JACKSON, MS 39213-7681
- **Mailing address phone:** (601) 700-7709
- **Mailing address fax:** (877) 852-6352

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/27/2012
- **Last updated:** 03/12/2015