# NCC

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

## Provider details

- **NPI number:** 1376195727
- **Authorized official:** J. NOLAN (OFFICE MANAGER)
- **Authorized official phone:** (601) 376-9322

## Contact information

- **Practice address:** 2416 SOUTHERLAND DRIVE, JACKSON, MS 39216-3762
- **Practice address phone:** (601) 683-3200
- **Mailing address:** 2416 SOUTHERLAND DRIVE, JACKSON, MS 39216
- **Mailing address phone:** (601) 376-9322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/15/2019
- **Last updated:** 07/01/2021