# PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jackson South OB/GYN Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629647995
- **Authorized official:** MARK T KNIGHT (EVP CHEIF FINANCIAL OFFICER)
- **Authorized official phone:** (305) 585-7979

## Contact information

- **Practice address:** 15155 SW 97TH AVE STE 230, MIAMI, FL 33176-7016
- **Practice address phone:** (305) 585-5259
- **Mailing address:** PO BOX 12493, MIAMI, FL 33101-2493
- **Mailing address phone:** (786) 466-8101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/22/2021
- **Last updated:** 06/22/2021