# MEDICAL MALL HEALTH SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medical Mall Health Services of Jackson
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881975621
- **Authorized official:** JAMES C BARDWELL (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (202) 448-2983

## Contact information

- **Practice address:** 450 WOODROW WILSON DRIVE, SUITE 499A, JACKSON, MS 39312-4101
- **Practice address phone:** (601) 500-7709
- **Mailing address:** 2820 BLADENSBURG ROAD, NE, WASHINGTON, DC 20018-4101
- **Mailing address phone:** (202) 448-2983

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/07/2011
- **Last updated:** 09/07/2011