Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Centerwell Senior Primary Care MS PC

Organization Family Medicine Physician · NPI 1710693619

Centerwell Senior Primary Care MS PC is a Family Medicine Physician in Jackson, Mississippi. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
3
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1220 E Northside Dr Ste 220
Jackson, MS 39211-5503
Phone: (601) 298-4173
Fax: (877) 866-2356
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Family Medicine Physician Taxonomy 207Q00000X
General Practice Physician Taxonomy 208D00000X

Record details

NPI number1710693619
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationCenterwell Senior Primary Care MS PC
Authorized official Angie Martinez — Senior Credentialing Professional · (407) 447-7120
Other names Centerwell Senior Primary Care-Jackson East
NPI enumeratedJanuary 25, 2023
Last updated in NPPESJuly 3, 2024
Certification dateJuly 3, 2024
Mailing address6101 Blue Lagoon Dr Ste 200, Miami, FL 33126-3168

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