Organization
JACKSON NEUROSURGERY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZOE LEWIS (PRACTICE ADMINISTRATOR)
(601) 366-1011
Entity
Organization
Contact information
Practice address
971 LAKELAND DR, SUITE 1250, JACKSON, MS 39216-4643
(601) 366-1011
(601) 366-7311
Mailing address
971 LAKELAND DR, SUITE 1250, JACKSON, MS 39216-4643
(601) 366-1011
(601) 366-7311
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08288260
—
MS
01
—
CK4238
RAILROAD MEDICARE
MS
Enumeration date
10/20/2009
Last updated
05/04/2015
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