NPIMap

Organization Active NPI

Jackson Public Schools Dba Galloway Clinic

  • Registered Nurse
  • Jackson, MS
National Provider Identifier
1710022959
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
R857457 Issued in MS
Legal business name
JACKSON PUBLIC SCHOOLS DBA GALLOWAY CLINIC
Practice address
186 Idlewild St
Jackson, MS 39203-1219
Phone
(601) 360-2214
Fax
(601) 360-2212
NPI assigned
Feb 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Earl Watkins, PH.D
Title
Superintendent
Phone
(601) 960-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163W00000X R857457 MS Primary

Addresses

Primary practice location

186 Idlewild St
Jackson, MS 39203-1219

Mailing address

662 S President St
Jackson, MS 39201-5601
Phone (601) 960-8705

Other identifiers 1

IdentifierTypeStateIssuer
04358817MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Jackson Public School District13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710022959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "662 S PRESIDENT ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392015601",
            "telephone_number": "601-960-8705",
            "fax_number": "601-960-8704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 IDLEWILD ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392031219",
            "telephone_number": "601-360-2214",
            "fax_number": "601-360-2212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PUBLIC SCHOOLS DBA GALLOWAY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "EARL",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "601-960-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "R857457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04358817",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.