# FAIRMOUNT FAMILY MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Camillus Family Health Assoc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659491421
- **Authorized official:** DR. LELAND J JACKSON MD (OWNER)
- **Authorized official phone:** (315) 234-2342

## Contact information

- **Practice address:** 5006 WEST GENESEE STREET, CAMILLUS, NY 13031-2326
- **Practice address phone:** (315) 234-2342
- **Practice address fax:** (315) 234-0697
- **Mailing address:** 5006 WEST GENESEE STREET, CAMILLUS, NY 13031-2326
- **Mailing address phone:** (315) 234-2342
- **Mailing address fax:** (315) 234-0697

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 11/29/2023