| NPI | 1295570083 |
|---|---|
| Former Legal Business Name | PRIMARY CARE SOUTH LLC |
| Doing Business As | SOUTH JACKSON MEDICAL & WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | MARANDA HAYNES Chief Compliance 731-427-0470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2024-08-16 |