Organization
COPAC ADDICTION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA NEWTON JOHNSON CFNP (FAMILY NURSE PRACTITIONER)
(601) 829-2500
Entity
Organization
Contact information
Practice address
3949 HIGHWAY 43 N, BRANDON, MS 39047-7240
(601) 829-2500
(601) 829-4278
Mailing address
5857 KRISTEN DR, JACKSON, MS 39211-2831
(601) 956-0303
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
R586986
MS
Other
Enumeration date
12/28/2006
Last updated
03/07/2023
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