| Jackson Neurocare, Pllc | |
|
971 Lakeland Drive Suite 557, West Tower Jackson MS 39216-4607 | |
| (601) 939-0361 | |
| (601) 939-5210 |
| Full Name | Jackson Neurocare, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 971 Lakeland Drive, Jackson, Mississippi |
| Authorized Official Name and Position | Ruth Kellum Fredericks (OWNER) |
| Authorized Official Contact | 6019390361 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Neurocare, Pllc 971 Lakeland Drive Suite 557, West Tower Jackson MS 39216-4607 Ph: (601) 939-0361 | Jackson Neurocare, Pllc 971 Lakeland Drive Suite 557, West Tower Jackson MS 39216-4607 Ph: (601) 939-0361 |
| NPI Number | 1770987638 |
|---|---|
| Provider Enumeration Date | 10/21/2014 |
| Last Update Date | 10/21/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770987638 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 11722 (Mississippi) | Primary |
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