Healthcare Provider Details

I. General information

NPI: 1710201454
Provider Name (Legal Business Name): LAURA E MCCALOP DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 OLD CANTON RD SUITE 305
JACKSON MS
39216-4200
US

IV. Provider business mailing address

3000 OLD CANTON RD SUITE 305
JACKSON MS
39216-4200
US

V. Phone/Fax

Practice location:
  • Phone: 601-681-1550
  • Fax: 601-981-0804
Mailing address:
  • Phone: 601-681-1550
  • Fax: 601-981-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA M WIGGINGTON
Title or Position: OWNER
Credential: D.O.
Phone: 601-981-1550