Organization Name: | JACKSON EAR CLINIC PA |
NPI Number: | 1093934002 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONNA T WINDHAM (CLINIC MANAGER) |
Mailing Address: | 971 Lakeland Dr Suite 854 Jackson |
State: | MS US |
Postal Code: | 392164643 |
Phone Number: | 6019812825 |
Fax Number: | 6019812827 |
NPI Enumeration Date: | 04/25/2007 |
NPI Last Update Date: | 09/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 11369 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |