Organization
MALL SERVICES, LLC
Active
Other names
809 Convenient Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTAL ROGERS LPN (OFFICE ASSISTANT)
(601) 982-0673
Entity
Organization
Contact information
Practice address
809 N STATE ST, JACKSON, MS 39202-2604
(601) 982-0673
(601) 982-0459
Mailing address
350 W WOODROW WILSON AVE, SUITE 615, JACKSON, MS 39213-7681
(601) 982-0673
(601) 982-0459
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
P320574
MS
363LF0000X
Family Nurse Practitioner
Primary
R656046
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115980
—
MS
05
—
08406271
—
MS
Enumeration date
01/08/2009
Last updated
01/08/2009
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