Healthcare Provider Details

I. General information

NPI: 1770790214
Provider Name (Legal Business Name): JACKSON EAR, NOSE AND THROAT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N STATE ST SUITE 402
JACKSON MS
39202-1658
US

IV. Provider business mailing address

1421 N STATE ST SUITE 402
JACKSON MS
39202-1658
US

V. Phone/Fax

Practice location:
  • Phone: 601-352-7655
  • Fax: 601-352-7658
Mailing address:
  • Phone: 601-352-7655
  • Fax: 601-352-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number07717
License Number StateMS

VIII. Authorized Official

Name: DR. WILLIAM F SNEED
Title or Position: OWNER
Credential: M.D.
Phone: 601-352-7655