Organization
ST DOMINIC MEDICAL ASSOCIATES LLC
Active
Parent organization
ST DOMINIC JACKSON MEMORIAL HOSPITAL
Other names
St Dominic Neuroscience Center
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
971 LAKELAND DR, SUITE 557, JACKSON, MS 39216-4643
(601) 200-4560
(601) 200-4850
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4560
(601) 200-4580
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
21151
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07430597
—
MS
Enumeration date
01/29/2014
Last updated
10/28/2019
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