Provider Demographics
NPI:1255879789
Name:YAZOO FEDERAL CORRECTIONAL CENTER
Entity type:Organization
Organization Name:YAZOO FEDERAL CORRECTIONAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NATIONAL CONTACT FOR THE NHSC PROGR
Authorized Official - Prefix:
Authorized Official - First Name:SONJIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-353-4110
Mailing Address - Street 1:2125 SCANLON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-4423
Mailing Address - Country:US
Mailing Address - Phone:601-260-6330
Mailing Address - Fax:
Practice Address - Street 1:2225 HALEY BARBOUR PKWY
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-4796
Practice Address - Country:US
Practice Address - Phone:662-751-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF1015502261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health