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Organization
ST. DOMINIC MEDICAL ASSOCIATES LLC
Active
Organization
ST. DOMINIC MEDICAL ASSOCIATES LLC
Active
Other names
Family Practice Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE STUART (CREDENTIALING SPECIALIST)
(601) 200-4880
Entity
Organization
Contact information
Practice address
1050 RIVER OAKS DR, SUITE 100, FLOWOOD, MS 39232-9564
(601) 200-4760
Mailing address
PO BOX 23666, JACKSON, MS 39225-0000
(601) 200-4769
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/19/2006
Last updated
07/16/2019
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