Organization
JACKSON RADIOLOGY ASSOC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY C STILL (OFFICE MANAGER)
(601) 373-6441
Entity
Organization
Contact information
Practice address
1860 CHADWICK DR, STE 204, JACKSON, MS 39204-3463
(601) 373-6441
(601) 373-5715
Mailing address
1860 CHADWICK DR, STE 204, JACKSON, MS 39204-3463
(601) 373-6441
(601) 373-5715
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09011188
—
MS
01
—
C00236
MEDICARE
MS
01
—
CB8434
RAILROAD MEDICARE
MS
Enumeration date
03/09/2007
Last updated
05/20/2008
Update your record
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