Organization
WEST JACKSON MEDICINE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY L JORDAN R.PH (OWNER PHARMACIST)
(706) 654-3690
Entity
Organization
Contact information
Practice address
3845 HWY 53, HOSCHTON, GA 30548
(706) 654-3690
(706) 654-1238
Mailing address
3845 HIGHWAY 53, P.O. BOX 271, HOSCHTON, GA 30548
(706) 654-3690
(706) 654-1238
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
005816
GA
333600000X
Pharmacy
005816
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000230238A
—
GA
Enumeration date
12/13/2006
Last updated
05/05/2009
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