# HMG GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fondren Care Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255738035
- **Authorized official:** JOHNATHAN CHAD GIBSON (OFFICE MANAGER)
- **Authorized official phone:** (601) 951-9197

## Contact information

- **Practice address:** 4436 N STATE ST, SUITE A1, JACKSON, MS 39206-5334
- **Practice address phone:** (601) 383-2036
- **Practice address fax:** (601) 981-5819
- **Mailing address:** 4436 N STATE ST, SUITE A1, JACKSON, MS 39206-5334
- **Mailing address phone:** (601) 383-2036
- **Mailing address fax:** (601) 981-5819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 07980 | MS | Yes |
| 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