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969 Lakeland Dr St Thomas Hall Jackson MS 39216-4606 | |
| (601) 200-3110 | |
| (601) 200-3109 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 969 Lakeland Dr, Jackson, Mississippi |
| Authorized Official Name and Position | Danielle Stuart (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 6012004880 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 23666 Jackson MS 39225-3666 Ph: (601) 200-3100 | 969 Lakeland Dr St Thomas Hall Jackson MS 39216-4606 Ph: (601) 200-3110 |
| NPI Number | 1386708188 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 08/11/2021 |
| Certification Date | 08/11/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386708188 | NPI | - | NPPES |
| 00784213 | Medicaid | MS |
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