JACKSON PEDIATRIC ASSOCIATES P A NPI 1659556298

NPI Information

JACKSON PEDIATRIC ASSOCIATES P A is a specialist in Jackson, MS. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. JACKSON PEDIATRIC ASSOCIATES P A NPI is 1659556298. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Chadwick Drive Clinic.

The provider's business location address is:

1824 HOSPITAL DR
JACKSON, MS
ZIP 39204-410
Phone: (601) 346-4586
Fax: (601) 346-4587

The provider's authorized official is Yolanda W Wilson .
The authorized official title is President and has the following contact phone number (601) 707-5381.

The CLIA number assigned to this NPI record is 25D0989851 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/2/2008 and was last updated on 11/15/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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