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

Fondren Medical Clinic

Organization Primary Care Clinic/Center · NPI 1043573199

Fondren Medical Clinic is a Primary Care Clinic/Center in Jackson, Mississippi. Registered with an NPI since 2012.

In the registry since
2012

Practice location Address checks out

4436 N State St Ste A-1
Jackson, MS 39206-5334
Phone: (769) 257-5339
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Clinic/Center (primary) Taxonomy 261QP2300X

Record details

NPI number1043573199
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Theresa Lane-Fisher — Physician/Owner · (769) 257-5336
NPI enumeratedJune 22, 2012
Last updated in NPPESJune 22, 2012
Mailing address4436 N State St, Suite A-1, Jackson, MS 39206-5334

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