# PRIME CARE CLINIC OF CLINTON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790444263
- **Authorized official:** JUSTIN C JACKSON (MEMBER/COO)
- **Authorized official phone:** (601) 519-7692

## Contact information

- **Practice address:** 709 CLINTON PKWY, CLINTON, MS 39056-5245
- **Practice address phone:** (601) 259-9532
- **Mailing address:** PO BOX 785, CLINTON, MS 39060-0785
- **Mailing address phone:** (601) 519-7692

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/13/2021
- **Last updated:** 01/25/2022