Provider Demographics
NPI:1902178346
Name:BAPTIST JACKSON HEART CARDIOLOGY CLINIC-MAGEE
Entity Type:Organization
Organization Name:BAPTIST JACKSON HEART CARDIOLOGY CLINIC-MAGEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-292-4262
Mailing Address - Street 1:360 SIMPSON HIGHWAY 149
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3841
Mailing Address - Country:US
Mailing Address - Phone:601-982-7850
Mailing Address - Fax:601-944-9780
Practice Address - Street 1:1600 N STATE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1689
Practice Address - Country:US
Practice Address - Phone:601-944-1717
Practice Address - Fax:601-944-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty