OrganizationActive
Fondren Medical Clinic
NPI 1043573199 · Primary Care Clinic/Center · Jackson, MS
Fondren Medical Clinic is a Primary Care Clinic/Center organization in Jackson, MS (NPI 1043573199).
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
Profile Score
Detailed profile(80/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4436 N State St
Suite A-1
Jackson, MS 39206-5334
Phone: (769) 257-5339
Street-level locationGet directions
Mailing address
4436 N State St
Jackson, MS 39206-5334
Registry dates
- Enumerated
- 2012-06-22
- Last updated
- 2012-06-22
Frequently asked questions
- What is Fondren Medical Clinic's NPI number?
- Fondren Medical Clinic's National Provider Identifier (NPI) is 1043573199, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Fondren Medical Clinic?
- Fondren Medical Clinic is classified in the NPPES registry as Primary Care Clinic/Center (Ambulatory Health Care Facilities).
- Where is Fondren Medical Clinic located?
- Fondren Medical Clinic's practice location on file with NPPES is 4436 N State St, Jackson, MS 39206-5334.
- What is Fondren Medical Clinic's phone number?
- The practice phone number listed in the NPPES registry for Fondren Medical Clinic is (769) 257-5339.
- Who is the authorized official for Fondren Medical Clinic?
- The authorized official listed on Fondren Medical Clinic's NPPES record is Theresa Lane-Fisher, Physician/Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Fondren Medical Clinic's NPI active?
- Yes — Fondren Medical Clinic's NPI (1043573199) is active in the NPPES registry as of the last update on 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.