Healthcare Provider Details

I. General information

NPI: 1154584811
Provider Name (Legal Business Name): JASMINE SANDHU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. JASMINE SINGH

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 180
JACKSON MS
39202-2027
US

IV. Provider business mailing address

475 FAIRFIELD DR
MADISON MS
39110-8597
US

V. Phone/Fax

Practice location:
  • Phone: 601-414-0484
  • Fax: 601-500-5060
Mailing address:
  • Phone: 601-519-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number724-L
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number21576
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: