# ST. DOMINIC MEDICAL ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St Dominic Family Practice Associates Gluckstadt, St Dominic Family Practice Associates Madison
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245393255
- **Authorized official:** DANIELLE STUART (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (601) 200-4880

## Contact information

- **Practice address:** 106 HIGHLAND WAY, SUITE 103, MADISON, MS 39110-6929
- **Practice address phone:** (601) 200-4750
- **Practice address fax:** (601) 200-4740
- **Mailing address:** PO BOX 23666, JACKSON, MS 39225-3666
- **Mailing address phone:** (601) 200-4749
- **Mailing address fax:** (601) 200-5929

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/19/2006
- **Last updated:** 08/31/2018