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FONDREN MEDICAL CLINIC
NPI 1043573199
Clinic/Center - Primary Care in Jackson, MS

Active since June 22, 2012
4436 N STATE ST, SUITE A-1, JACKSON, MS 39206(769) 257-5339 Get Directions Write a Review

NPPES record last updated: June 22, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Fondren Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FONDREN MEDICAL CLINIC (NPI 1043573199) is a healthcare organization registered as a primary care in Jackson, Mississippi and active in the NPI registry since June 2012. The organization lists Theresa Leijuan Lane-fisher, Physician/owner, as its authorized official.

NPPES Registry Identity

NPI1043573199
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameFONDREN MEDICAL CLINIC
Location Address4436 N STATE ST, SUITE A-1Jackson, MS 39206-5334
Mailing Address4436 N State St, Suite A-1Jackson, MS 39206-5334 · (769) 257-5339
Phone(769) 257-5339
Organization SubpartNo
Authorized OfficialTheresa Leijuan Lane-fisherPhysician/owner · (769) 257-5336
Enumeration DateJune 22, 2012
✔ NPI 1043573199 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
4436 N STATE ST, Jackson, MS 39206
Open in Google Maps ↗

Other Identifiers 1

Medicaid00125523MS

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HMG GROUP LLC
Family Medicine
4436 N STATE ST, SUITE A1
JACKSON, MS 39206
Hinds County (601) 383-2036

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fondren Medical Clinic's NPI number?

The NPI number for Fondren Medical Clinic is 1043573199. It was assigned to this organization in the NPPES registry on June 22, 2012.

Where is Fondren Medical Clinic located?

Fondren Medical Clinic is located at 4436 N State St Suite A-1, Jackson, MS 39206. The listed phone number is (769) 257-5339.

What is Fondren Medical Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Fondren Medical Clinic was last updated on June 22, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.