Dr. Tim Jackson

LBN: Moriah
Dr. Tim Jackson is an health care organization with primary practice located at 12080 New Orleans Ave N , Gulfport MS 39503-3180. The organization recently has only one registered license in Other Service Providers / Specialist, which is considered as the primary health care specialty. Moriah can be contacted via phone (228) 832-9933, or through Jackson, Timothy D via phone (228) 832-9933.

Contact Information

Primary practice address
12080 New Orleans Ave N Gulfport MS 39503-3180
Phone: (228) 832-9933
Fax: (228) 832-9916
Website:
Map and Directions
Authorized official contact:
Name: Jackson, Timothy D Doctor of Medicine (MD)
Phone: (228) 832-9933

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 14510 Mississippi

Profile Details

NPI number 1003958117
LBN Legal business name Moriah
DBA Doing business as Dr. Tim Jackson
Authorized official Jackson, Timothy D Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 13th, 2007
Last updated Aug 22nd, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003958117 NPPES
Mississippi MEDICAID 00124986

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