Organization
ST. DOMINIC MEDICAL ASSOCIATES, LLC
Active
Parent organization
ST. DOMINIC-JACKSON MEMORIAL HOSPITAL
Other names
St. Dominic Dermatology
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. DOMINIC-JACKSON MEMORIAL HOSPITAL
Authorized official
DANIELLE STUART (CREDENTIALING SPECIALIST)
(601) 200-4880
Entity
Organization
Contact information
Practice address
106 HIGHLAND WAY STE 208, MADISON, MS 39110-6929
(601) 200-3376
(601) 200-4475
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-3376
(601) 200-4475
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
10/16/2020
Last updated
05/26/2021
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