Healthcare Provider Details

I. General information

NPI: 1356649768
Provider Name (Legal Business Name): ROBERT ABNEY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 CRANE RIDGE DR SUITE 101-B
JACKSON MS
39216-4910
US

IV. Provider business mailing address

1867 CRANE RIDGE DR SUITE 101-B
JACKSON MS
39216-4910
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-8776
  • Fax: 601-354-8786
Mailing address:
  • Phone: 601-362-8776
  • Fax: 601-354-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4630
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: