# JACKSON PUBLIC SCHOOLS MCWILLIE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** McWillie Elementary School Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518140599
- **Authorized official:** MRS. TAMMY D CROCKER R.N. (LEAD NURSE)
- **Authorized official phone:** (601) 209-4456

## Contact information

- **Practice address:** 4851 MCWILLIE CIR, JACKSON, MS 39206-5025
- **Practice address phone:** (601) 209-4456
- **Practice address fax:** (601) 960-8704
- **Mailing address:** 618 S PRESIDENT ST, JACKSON, MS 39201-5601
- **Mailing address phone:** (601) 960-8705

## Taxonomy

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

## Other

- **Enumeration date:** 12/12/2007
- **Last updated:** 12/12/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 02074355 | — | MS |