Organization
VA JACKSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM TIDWELL (RADIOLOGY)
(601) 898-4777
Entity
Organization
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 364-1359
Mailing address
158 FRENCH BR, MADISON, MS 39110-8173
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
—
—
Other
Enumeration date
11/28/2006
Last updated
07/10/2007
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