Fondren Medical Clinic
NPI #1043573199 in Jackson, Mississippi
Provider Information
- NPI Number
- 1043573199
- Entity Type
- Organization
- Organization Name
- Fondren Medical Clinic
- Primary Specialty
- Clinic/Center - Primary Care
- Enumeration Date
- Jun 22, 2012
- Last Updated
- Jun 22, 2012
Practice Location
- Address
- 4436 N STATE ST
- Address 2
- SUITE A-1
- City
- Jackson
- State
- Mississippi
- ZIP Code
- 39206-5334
- Phone
- (769) 257-5339
Authorized Official
- Name
- DR. THERESA LEIJUAN LANE-FISHER, P.H,D,PA
- Title
- PHYSICIAN/OWNER
- Phone
- (769) 257-5336
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Primary Care — Primary Care |
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