Provider Demographics
NPI:1144370776
Name:JACKSON IMAGING
Entity type:Organization
Organization Name:JACKSON IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:AMACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-936-0302
Mailing Address - Street 1:1045 N FLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9533
Mailing Address - Country:US
Mailing Address - Phone:601-936-0302
Mailing Address - Fax:601-936-3416
Practice Address - Street 1:1045 N FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9533
Practice Address - Country:US
Practice Address - Phone:601-936-0302
Practice Address - Fax:601-936-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty