Provider Demographics
NPI:1033455852
Name:GLOBAL TREATMENT CLINIC OF JACKSON LLC
Entity Type:Organization
Organization Name:GLOBAL TREATMENT CLINIC OF JACKSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALANNA
Authorized Official - Middle Name:JILLIAN
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-665-7256
Mailing Address - Street 1:2460 TERRY RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-5767
Mailing Address - Country:US
Mailing Address - Phone:601-665-7256
Mailing Address - Fax:601-373-1767
Practice Address - Street 1:2460 TERRY RD
Practice Address - Street 2:SUITE 800
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-5767
Practice Address - Country:US
Practice Address - Phone:601-373-1766
Practice Address - Fax:601-373-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR854233261QC1500X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS251290930AOtherBLUE CROSS BLUE SHIELD OF MISSISSIPPI
MS30250I2670OtherMEDICARE PTAN#