Organization
MTN ORTHOXPRESS HOLDINGS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER C BULLOCK (PRESIDENT)
(662) 534-2227
Entity
Organization
Contact information
Practice address
11645 HIGHWAY 51 S STE 103, ATOKA, TN 38004-2001
(901) 407-2221
(901) 407-2300
Mailing address
206 OXFORD RD, NEW ALBANY, MS 38652-3115
(662) 534-2227
(662) 534-5542
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/29/2022
Last updated
06/10/2024
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