is a Developmental - Behavioral Pediatrics in Jackson, Mississippi. practices all healthcare services and medical treatments related to Developmental - Behavioral Pediatrics. The NPI Number for is 1487811311. The last update date is .
's current location address is 2500 N State St, Jackson, Mississippi. You can contact this provider via phone number 6019845236. The mailing address for is 2500 N State St, Jackson, Mississippi. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 2500 N State St, Jackson, Mississippi |
| Phone Number | 6019845236 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1487811311 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 2500 N State St |
|---|---|
| City | Jackson |
| State | Mississippi (MS) |
| Post Code | 392164500 |
| Phone Number | 6019845236 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Developmental - Behavioral Pediatrics |
|---|---|
| Taxonomy | 2080P0006X |
| Licence No | 11421 |
|
Definition: A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy effort |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 10860 | MS | -- | |
| 302I379888 | MS | MEDICARE PTAN |
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