Individual provider · Type 1 NPI

Omar Hasan

Student in an Organized Health Care Education/Training Program · Jackson, MS

NPI number 1124681705 Active

Practice location

2500 N State St # N408
Jackson, MS 39216-4500

Call (601) 984-2828 Map

Mailing address

4639 Kirkley Dr
Jackson, MS 39206-3301

Specialties and licenses

TaxonomyCodeLicense
General Practice Physician 208D00000XME160204 (FL)
Student in an Organized Health Care Education/Training Program 390200000XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XT-5146 (MS)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1124681705

Omar Hasan's National Provider Identifier is 1124681705, issued on Apr 18, 2019. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Jackson, MS. The record was last updated on Jul 10, 2023.