Organization
ST DOMINIC MEDICAL ASSOCIATES LLC
Active
Parent organization
ST DOMINIC JACKSON MEMORIAL HOSPITAL
Other names
St Dominic Raleigh Family Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST DOMINIC JACKSON MEMORIAL HOSPITAL
Authorized official
DANIELLE STUART (CREDENTIALING SPECIALIST)
(601) 200-4880
Entity
Organization
Contact information
Practice address
342 MAGNOLIA DR, RALEIGH, MS 39153-6012
(601) 200-6809
(601) 200-5929
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16442
MS
Other
Enumeration date
04/04/2014
Last updated
07/02/2019
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