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Organization
MALL SERVICES, LLC
Active
Organization
MALL SERVICES, LLC
Active
Other names
THE VILLAGE CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTAL ROGERS LPN (CLINIC MANAGER)
(601) 952-0673
Entity
Organization
Contact information
Practice address
386 RAYMOND RD, BUILDING 30, JACKSON, MS 39204-3700
(601) 982-0673
(601) 982-0459
Mailing address
350 W WOODROW WILSON AVE, SUITE 615, JACKSON, MS 39213-7681
(601) 982-0673
(601) 982-0459
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/08/2010
Last updated
01/08/2010
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