Organization
SONNY MONTGOMERY V A M EDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA RUTH MACK MSN NURSING (CERTIFIED NURSE PRACTITIONER)
(601) 362-4471
Entity
Organization
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
Mailing address
1973 HOUSTON RD, BOLTON, MS 39041-9387
(601) 866-2429
Taxonomy
Speciality
Code
Description
License number
State
281P00000X
Chronic Disease Hospital
Primary
R725005
MS
Other
Enumeration date
09/17/2006
Last updated
08/22/2020
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