OrganizationActive
Fondren Medical Clinic
NPI 1043573199 · Primary Care Clinic/Center · Jackson, MS
Provider details
- NPI number
- 1043573199
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Theresa Lane-Fisher, Physician/Owner(769) 257-5336
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
4436 N State St
Suite A-1
Jackson, MS 39206-5334
Phone: (769) 257-5339
Approximate (ZIP-level) locationGet directions
Mailing address
4436 N State St
Jackson, MS 39206-5334
Registry dates
- Enumerated
- 2012-06-22
- Last updated
- 2012-06-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.