Organization
COPAC INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERALD STACY HUGHES, JR. PHD, LPC (CEO)
(601) 829-2500
Entity
Organization
Contact information
Practice address
4309 LAKELAND DR, FLOWOOD, MS 39232-8947
(601) 829-2500
(601) 932-3857
Mailing address
4309 LAKELAND DR, FLOWOOD, MS 39232-8947
(601) 829-2500
(601) 932-3857
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
FS39-DADA-OP-01
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119422
—
MS
01
—
1073679817
NURSE PRACTITIONER
MS
01
—
1235270885
COPAC INCORPORATED
MS
01
—
1316016066
PHYSICIAN
MS
01
—
1730289802
PHYSICIAN
MS
01
—
1801997127
PHYSICIAN
MS
Enumeration date
03/28/2007
Last updated
10/30/2007
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