Most Relevant Information
Provider Data
| NPI Number: | 1003420092 |
| Provider Name: | MERRICK GREENE JACKSON NP |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/07/2020 |
| Last Updated: | 09/28/2021 |
Provider Practice Location
1430 JEFFERSON ST
LAUREL
MS
394404243
Practice Location Phone/Fax
| Phone: | 6014252273 |
| Fax: | 6014269637 |
Provider Mailing Location
120 NATALIE LN
HATTIESBURG
MS
394023080
Provider Mailing Phone/Fax
| Phone: | 6019385197 |
| Fax: |