Organization
ST. DOMINIC MEDICAL ASSOCIATES LLC
Active
Other names
Family Practice Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE STUART (CREDENTIALING SPECIALIST)
(601) 200-4880
Entity
Organization
Contact information
Practice address
1050 RIVER OAKS DR, SUITE 100, FLOWOOD, MS 39232-9564
(601) 200-4760
Mailing address
PO BOX 23666, JACKSON, MS 39225-0000
(601) 200-4769
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06676033
—
MS
Enumeration date
12/19/2006
Last updated
07/16/2019
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