Healthcare Provider Details

I. General information

NPI: 1770847154
Provider Name (Legal Business Name): RYAN MCGAUGHEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 LAKELAND DR STE 45
JACKSON MS
39216-4640
US

IV. Provider business mailing address

3688 VETERANS MEMORIAL DR
HATTIESBURG MS
39401-8246
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-4690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number24480
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number56573
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number56573
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number24480
License Number StateMS
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24480
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: