Healthcare Provider Details

I. General information

NPI: 1891136818
Provider Name (Legal Business Name): JOHN ELGIN WILKAITIS, MD, MS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3531 LAKELAND DR
FLOWOOD MS
39232-8049
US

IV. Provider business mailing address

4500 I 55 FRONTAGE RD N STE 234
JACKSON MS
39211-5932
US

V. Phone/Fax

Practice location:
  • Phone: 601-829-4170
  • Fax:
Mailing address:
  • Phone: 601-982-8531
  • Fax: 601-982-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN ELGIN WILKAITIS
Title or Position: MEMBER
Credential:
Phone: 601-829-4170