Organization
MALL SERVICES, LLC
Active
Organization
MALL SERVICES, LLC
Active
Other names
Medical Mall Health Services at CMMC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AARON SHIRLEY M.D. (PROJECT DIRECTOR)
(601) 982-0673
Entity
Organization
Contact information
Practice address
1860 CHADWICK DR, SUITE 305, JACKSON, MS 39204-3463
(601) 503-4960
(601) 982-0459
Mailing address
350 W WOODROW WILSON AVE, SUITE 615, JACKSON, MS 39213-7681
(601) 982-0673
(601) 982-0459
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
10119
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08406271
—
MS
Enumeration date
12/27/2011
Last updated
12/27/2011
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