Organization
MALL SERVICES, LLC
Active
Other names
Lanier Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
AARON SHIRLEY MD (DIRECTOR)
(601) 982-0673
Entity
Organization
Contact information
Practice address
833 MAPLE ST, JACKSON, MS 39203-3844
(601) 982-0673
Mailing address
350 W WOODROW WILSON AVE, SUITE 615, JACKSON, MS 39213-7681
(601) 982-0673
(601) 982-0459
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
R729183
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08151531
—
MS
Enumeration date
12/18/2007
Last updated
12/18/2007
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