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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