# WEST JACKSON MEDICINE CENTER, INC

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

## Provider details

- **NPI number:** 1790846426
- **Authorized official:** MS. TRACY L JORDAN R.PH (OWNER PHARMACIST)
- **Authorized official phone:** (706) 654-3690

## Contact information

- **Practice address:** 3845 HWY 53, HOSCHTON, GA 30548
- **Practice address phone:** (706) 654-3690
- **Practice address fax:** (706) 654-1238
- **Mailing address:** 3845 HIGHWAY 53, P.O. BOX 271, HOSCHTON, GA 30548
- **Mailing address phone:** (706) 654-3690
- **Mailing address fax:** (706) 654-1238

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 005816 | GA | — |
| 333600000X | Pharmacy | 005816 | GA | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/13/2006
- **Last updated:** 05/05/2009