Organization
G.V. MONTGOMERY VA MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY D YOUNGBLOOD RN (RN)
(601) 320-8949
Entity
Organization
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 368-4498
Mailing address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 368-4498
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
R897708
MS
310400000X
Assisted Living Facility
P326213
MS
Other
Enumeration date
08/22/2014
Last updated
08/22/2014
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