South Jackson Medical & Wellness Center LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

SOUTH JACKSON MEDICAL & WELLNESS CENTER LLC

Practice address

1385 S Highland Ave Ste B1
Jackson, TN 38301-7547

Phone

(731) 427-0470

Fax

(731) 427-0995

NPI assigned

Jun 25, 2024

Organization subpart

No

Name

Maranda Haynes

Title

Chief Compliance

Phone

(731) 427-0470

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Morris, NP

  • Family Nurse Practitioner
  • Jackson, TN
  • NPI 1720732175

  TN

  Medicare reassignment NPD
• Nada Salloukh, DNP, APRN, FNP-C

  • Family Nurse Practitioner
  • Jackson, TN
  • NPI 1487490975

  TN

  Medicare reassignment NPD
• Tonya Freeman, FNP-C

  • Primary Care Nurse Practitioner
  • Middleton, TN
  • NPI 1265898282

  Primary Care

  NPD (past)
• Susan C Martin, FNP-BC

  • Primary Care Nurse Practitioner
  • Jackson, TN
  • NPI 1245227313

  Primary Care

  NPD (past)
• Kirkland Sturgis, FNP-C

  • Family Nurse Practitioner
  • Jackson, TN
  • NPI 1851983555
  NPD (past)
• Laura Farhat, APN-BC FNP

  • Family Nurse Practitioner
  • Ojai, CA
  • NPI 1194937102
  NPD (past)

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

• South Jackson Medical & Wellness Center Doing business as
• Primary Care South LLC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 16, 2024.

{
    "created_epoch": "1719273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1295570083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 291",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383020291",
            "telephone_number": "731-427-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1385 S HIGHLAND AVE STE B1",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383017547",
            "telephone_number": "731-427-0470",
            "fax_number": "731-427-0995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH JACKSON MEDICAL & WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-25",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "MARANDA",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE",
        "authorized_official_telephone_number": "731-427-0470"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Jackson Medical & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Primary Care South LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Steven Anthony Sopcak, D.C.
• Sidhartha Sorker, OTR/L
• Christy Ann Sorrell, PT
• Bob T Souder, MD
• Sound Mind Counseling
• Southeastern Hematology Oncology Associates PLLC
• Southern Hands Quality Care
• Alanson R Spalding III, M.D.
• Monica Marlean Spann, SLP
• Elizabeth Sparkman, PTA

• All providers in Jackson, TN
• Primary Care Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.