Organization
ANN MARSHALL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN MARSHALL (ADMINISTRATOR)
(601) 624-3352
Entity
Organization
Contact information
Practice address
2964 TERRY RD, JACKSON, MS 39212-3055
(601) 624-3352
Mailing address
2964 TERRY RD, JACKSON, MS 39212-3055
(601) 624-3352
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00422291
—
MS
Enumeration date
05/05/2016
Last updated
05/05/2016
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