Organization
CENTRAL JACKSON FAMILY MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CASSANDRA FAYE THOMAS M.D. (PHYSICAIN)
(601) 981-7198
Entity
Organization
Contact information
Practice address
514 C WOODROW WILSON, JACKSON, MS 39216
(601) 981-7198
(601) 981-6616
Mailing address
P.O. BOX 4610, JACKSON, MS 39296-4610
(601) 981-7198
(601) 981-6616
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
13653
MS
261QM2500X
Medical Specialty Clinic/Center
18905
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112137
—
MS
05
—
00937242
—
MS
Enumeration date
04/20/2007
Last updated
12/09/2010
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