Organization
CENTRAL JACKSON MEDICAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IPHOGENIER BARRY (PRESIDENT)
(601) 981-7198
Entity
Organization
Contact information
Practice address
514 C E WOODROW WILSON, JACKSON, MS 39216-4538
(601) 981-7198
(601) 981-6616
Mailing address
514 C E WOODROW WILSON, JACKSON, MS 39216-4538
(601) 981-7198
(601) 981-6616
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R718637
MS
363LF0000X
Family Nurse Practitioner
Primary
R733308
MS
Other
Enumeration date
09/14/2009
Last updated
09/14/2009
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