Organization
ST. DOMINIC JACKSON MEMORIAL
Active
Other names
St Dominic Emergency Room
Organization subpart
No
Provider details
NPI number
Authorized official
KARL HATTEN M.D. (DIRECTOR)
(601) 200-2000
Entity
Organization
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-2000
Mailing address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-2000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
MS
207P00000X
Emergency Medicine Physician
Primary
—
MS
208600000X
Surgery Physician
—
MS
367500000X
Certified Registered Nurse Anesthetist
—
MS
367H00000X
Anesthesiologist Assistant
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014778
—
MS
Enumeration date
06/16/2006
Last updated
08/11/2010
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