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Organization
HMG GROUP LLC
Active
Organization
HMG GROUP LLC
Active
Other names
Fondren Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNATHAN CHAD GIBSON (OFFICE MANAGER)
(601) 951-9197
Entity
Organization
Contact information
Practice address
4436 N STATE ST, SUITE A1, JACKSON, MS 39206-5334
(601) 383-2036
(601) 981-5819
Mailing address
4436 N STATE ST, SUITE A1, JACKSON, MS 39206-5334
(601) 383-2036
(601) 981-5819
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
07980
MS
363LA2200X
Adult Health Nurse Practitioner
R860365
MS
363LF0000X
Family Nurse Practitioner
R878138
MS
363LW0102X
Women's Health Nurse Practitioner
R860365
MS
Other
Enumeration date
11/22/2014
Last updated
11/22/2014
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