Healthcare Provider Details

I. General information

NPI: 1306546460
Provider Name (Legal Business Name): GENERATIONS NEUROPSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

109 ELIZABETH AVE
MADISON MS
39110-8329
US

V. Phone/Fax

Practice location:
  • Phone: 601-202-2472
  • Fax: 769-333-9172
Mailing address:
  • Phone: 601-826-7841
  • Fax: 769-333-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNELIZABETH ROBINSON CARLEW
Title or Position: NEUROPSYCHOLOGIST
Credential: PHD
Phone: 601-202-2472