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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | Thomas, Cassandra Central Jackson Family Medical | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States | [sources] | |||
| NPI | 1154549707 | [sources] | |||
| Sector | Group Physicians | [sources] | |||
| Status | not available | [sources] | |||
| Address | 514 Woodrow Wilson Ave, Ste C, Jackson, MS 39216 | [sources] | |||
| Last change | Last processed | First seen | |||
Service providers who have been terminated for cause from Mississippi's Medicaid program.
United States · Mississippi Division of Medicaid
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