Organization
NORTH JACKSON MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADESOLA F SHEKONI MD (PHYSICIAN)
(601) 713-0890
Entity
Organization
Contact information
Practice address
5160 GALAXIE DR, JACKSON, MS 39206-4308
(601) 713-0890
(601) 366-3415
Mailing address
PO BOX 4522, JACKSON, MS 39296-4522
(601) 713-0890
(601) 366-3415
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15143
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115572
—
MS
05
—
00117502
—
MS
01
—
109808399B
BLUECROSS OF MISSISSIPPI
MS
01
—
220338401B
BLUECROSS OF MISSISSIPPI
MS
05
—
9015073
—
MS
Enumeration date
09/22/2006
Last updated
04/08/2008
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