Provider Demographics
NPI:1487179156
Name:PATHWAY HEALTHCARE - JACKSON, MS, LLC
Entity type:Organization
Organization Name:PATHWAY HEALTHCARE - JACKSON, MS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-208-9312
Mailing Address - Street 1:1000 URBAN CENTER DR STE 600
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2584
Mailing Address - Country:US
Mailing Address - Phone:205-208-9312
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST STE 450
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2000
Practice Address - Country:US
Practice Address - Phone:205-208-9312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAY HEALTHCARE- MISSISSIPPI LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-03
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty