South Jackson Medical & Wellness Center LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

SOUTH JACKSON MEDICAL & WELLNESS CENTER LLC

Doing business as

South Jackson Medical & Wellness Center

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

Last updated

Aug 16, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maranda Haynes

Title

Chief Compliance

Phone

(731) 427-0470

Specialties & licenses 2

Addresses

Other names 2

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

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Morris, NP

  • Family Nurse Practitioner
  • Jackson, TN
  • NPI 1720732175
  Medicare reassignment NPD
• Nada Salloukh, DNP, APRN, FNP-C

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1487490975
  Medicare reassignment NPD
• Tonya Freeman, FNP-C

  • Primary Care Nurse Practitioner
  • Middleton, TN
  • NPI 1265898282
  NPD (past)
• Susan C Martin, FNP-BC

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

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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 (Southeastern Psychology Group)
• Southern Hands Quality Care
• Alanson R Spalding III, M.D.
• Monica Marlean Spann, SLP
• Elizabeth Sparkman, PTA

• Primary Care Nurse Practitioner in Jackson, TN
• Providers in Jackson, TN by specialty
• 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.