Organization
SOUTH JACKSON MEDICAL & WELLNESS CENTER LLC
Active
Other names
Primary Care South LLC, South Jackson Medical & Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARANDA HAYNES (CHIEF COMPLIANCE)
(731) 427-0470
Entity
Organization
Contact information
Practice address
1385 S HIGHLAND AVE STE B1, JACKSON, TN 38301-7547
(731) 427-0470
(731) 427-0995
Mailing address
PO BOX 291, JACKSON, TN 38302-0291
(731) 427-0470
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/25/2024
Last updated
08/16/2024
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