Organization
ST DOMINIC MEDICAL ASSOCIATES
Active
Parent organization
ST DOMINIC JACKSON MEMORIAL HOSPITAL
Other names
St Dominic's Gynecologic Oncology
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
971 LAKELAND DR, SUITE 750, JACKSON, MS 39216-4643
(601) 200-4970
(601) 200-5943
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01652268
—
MS
Enumeration date
01/04/2012
Last updated
03/16/2021
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