SOUTH JACKSON MEDICAL & WELLNESS CENTER
NPI 1295570083
Nurse Practitioner - Primary Care in Jackson, TN
About South Jackson Medical & Wellness Center NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTH JACKSON MEDICAL & WELLNESS CENTER (NPI 1295570083) is a healthcare organization registered as a primary care in Jackson, Tennessee and active in the NPI registry since June 2024. The organization holds a CLIA Waiver certificate valid through May 2, 2028 and lists Maranda Haynes, Chief Compliance, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 2
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
South Jackson Medical & Wellness Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to South Jackson Medical & Wellness Center, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 44D2112551
South Jackson Medical & Wellness Center, LLC · Jackson, TNFrequently 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 South Jackson Medical & Wellness Center LLC's NPI number?
The NPI number for South Jackson Medical & Wellness Center LLC is 1295570083. It was assigned to this organization in the NPPES registry on June 25, 2024. The provider is doing business as South Jackson Medical & Wellness Center. The provider was formerly known as Primary Care South LLC.
Where is South Jackson Medical & Wellness Center LLC located?
South Jackson Medical & Wellness Center LLC is located at 1385 S Highland Ave Ste B1, Jackson, TN 38301. The listed phone number is (731) 427-0470.
What is South Jackson Medical & Wellness Center LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is South Jackson Medical & Wellness Center LLC enrolled in Medicare?
Yes. South Jackson Medical & Wellness Center LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through South Jackson Medical & Wellness Center LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to South Jackson Medical & Wellness Center LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does South Jackson Medical & Wellness Center LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 44D2112551) is associated with this NPI, valid through May 2, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for South Jackson Medical & Wellness Center LLC was last updated on August 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# South Jackson Medical & Wellness Center · NPI 1295570083
Primary Care organization in Jackson, Tennessee. Organization record, active in the CMS NPPES registry since June 25, 2024.
## Identity
- **NPI:** 1295570083 (Entity type: Organization)
- **Enumerated:** June 25, 2024
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **Legal business name:** South Jackson Medical & Wellness Center Llc
- **Also known as:** Primary Care South LLC (Former Legal Business Name)
- **Organization subpart:** No
- **Authorized official:** Maranda Haynes, CHIEF COMPLIANCE
## Practice location
- **Address:** 1385 S HIGHLAND AVE STE B1, Jackson, TN 38301-7547
- **Phone:** (731) 427-0470 · **Fax:** (731) 427-0995
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 16, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1295570083) · Data from the CMS NPPES public registry.