Organization
PRIME CARE CLINIC OF CLINTON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN C JACKSON (MEMBER/COO)
(601) 519-7692
Entity
Organization
Contact information
Practice address
709 CLINTON PKWY, CLINTON, MS 39056-5245
(601) 259-9532
Mailing address
PO BOX 785, CLINTON, MS 39060-0785
(601) 519-7692
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578049276
—
MS
Enumeration date
12/13/2021
Last updated
01/25/2022
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