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2906 North State Street Suite 301 Jackson MS 39216 | |
| (601) 982-1001 | |
| (601) 982-1288 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 2906 North State Street, Jackson, Mississippi |
| Authorized Official Name and Position | Mitchell J Myers (OWNER) |
| Authorized Official Contact | 6019821001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Post Office Box 757 Jackson MS 39215 Ph: (601) 982-1001 | 2906 North State Street Suite 301 Jackson MS 39216 Ph: (601) 982-1001 |
| NPI Number | 1235454059 |
|---|---|
| Provider Enumeration Date | 04/05/2010 |
| Last Update Date | 04/12/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235454059 | NPI | - | NPPES |
| 0112521 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 10213 (Mississippi) | Primary |
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