# ST. DOMINIC MEDICAL ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST. DOMINIC-JACKSON MEMORIAL HOSPITAL
- **Other names:** St. Dominic Gastroenterology
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902374085
- **Legal business name:** ST. DOMINIC-JACKSON MEMORIAL HOSPITAL
- **Authorized official:** DANIELLE STUART (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (601) 200-4880

## Contact information

- **Practice address:** 971 LAKELAND DR STE 250, JACKSON, MS 39216-4620
- **Practice address phone:** (601) 200-5550
- **Practice address fax:** (601) 200-4887
- **Mailing address:** 971 LAKELAND DR STE 250, JACKSON, MS 39216-4620
- **Mailing address phone:** (601) 200-5550
- **Mailing address fax:** (601) 200-4887

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2018
- **Last updated:** 12/22/2022