Healthcare Provider Details

I. General information

NPI: 1992806939
Provider Name (Legal Business Name): IKECHUKWUI ERIATOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE STREET
JACKSON MS
39216-4505
US

IV. Provider business mailing address

2500 N STATE STREET STE. S108-A
JACKSON MS
39216-4505
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5900
  • Fax: 601-984-5939
Mailing address:
  • Phone: 601-984-5900
  • Fax: 601-984-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15724
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number15724
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: