JACKSON LUNG CLINIC (NPI# 1225105315) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225105315 |
| Entity Type | Organization |
| Organization Name | JACKSON LUNG CLINIC |
| Practice Address |
1151 N State St Suite 301 Jackson MS 39202-2407 |
| Mailing Address |
Po Box 967 Jackson MS 39205-0967 |
| Practice Telephone | 6013520041 |
| Practice Fax Number | 6013520043 |
| Mailing Telephone | 6019366001 |
| Mailing Fax Number | 6019364389 |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | WILLIAM FRAZIER (MANAGING OWNER) |
| Authorized Official Telephone | 6019366001 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09015305 | 05 |
| Street Address |
1151 N STATE ST SUITE 301 |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-2407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922003953 | Barry Whites | Internal Medicine | 1151 N State St, Ste 617, Jackson, MS 39202-2407 | 2005-06-16 |
| 1275182537 | Qianwen Williamson | Registered Nurse | 1151 N State St, Jackson, MS 39202-2407 | 2019-09-10 |
| 1982057592 | Deborah Fortenberry | Hearing Instrument Specialist | 1151 N State St, Suite 107, Jackson, MS 39202-2407 | 2016-07-19 |
| 1053729285 | Michael Garret Shumaker | Counselor | 1151 N State St, Jackson, MS 39202-2407 | 2014-07-31 |
| 1962823344 | Jackson Pain Center Pa | Anesthesiology | 1151 N State St, Suite 311, Jackson, MS 39202-2407 | 2014-01-02 |
| 1609137868 | Ellen C Lee | Nurse Practitioner | 1151 N State St, Suite 511, Jackson, MS 39202-2407 | 2012-06-05 |
| 1902032089 | Eric Welsh | Marriage & Family Therapist | 1151 N State St, Suite 212, Jackson, MS 39202-2407 | 2009-06-03 |
| 1659539351 | Medical Arts Dental Group P.a. | Dentist | 1151 N State St, Suite 401, Jackson, MS 39202-2407 | 2008-05-29 |
| 1750577805 | Live Oak Psychological Associtaes | Psychologist | 1151 N State St, Ste 212, Jackson, MS 39202-2407 | 2007-09-22 |
| 1154543627 | Sarah R. Guy | Anesthesiology | 1151 N State St, Suite 311, Jackson, MS 39202 | 2007-05-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
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| Taxonomy Code | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760564660 | William Thomas Williams Jr. | Internal Medicine | 1200 N State St Ste 500, Jackson, MS 39202-2027 | 2006-10-19 |
| 1104877703 | Medical Specialty Clinic P.C. | Internal Medicine | 27 Medical Center Dr, Jackson, TN 38301-3949 | 2006-05-16 |
| 1356392054 | George Vraney | Internal Medicine | 176 W University Pkwy, Suite C, Jackson, TN 38305-1618 | 2006-05-15 |
| 1972567683 | Robert George Monie | Internal Medicine | 100 Mission Blvd Ste 2200, Jackson, CA 95642-2536 | 2006-04-12 |
| 1922003953 | Barry Whites | Internal Medicine | 1151 N State St, Ste 617, Jackson, MS 39202-2407 | 2005-06-16 |
| 1356888218 | W.a. Foote Memorial Hospital, Inc | Internal Medicine | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| 1578965240 | Portis Medical Solutions LLC | Internal Medicine | 1225 N State St, Jackson, MS 39202-2064 | 2014-09-24 |
| 1275820847 | Brandon Pierce Garriga | Internal Medicine | 971 Lakeland Dr Ste 1052, Jackson, MS 39216-4609 | 2011-07-05 |
| 1326335902 | Charles E. Evans IIi | Internal Medicine | 971 Lakeland Dr Ste 1052, Jackson, MS 39216-4609 | 2011-07-05 |
| 1639478175 | Rajesh G Patel Md Pllc | Internal Medicine | 1225 N State St, Jackson, MS 39202-2064 | 2011-03-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.