Healthcare Provider Details

I. General information

NPI: 1407989619
Provider Name (Legal Business Name): DANA LORRAINE-JONES CARBO BRYANT M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA LORRAINE JONES CARBO

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 HOSPITAL DR
JACKSON MS
39204-3410
US

IV. Provider business mailing address

297 HIGHWAY 51 STE B
RIDGELAND MS
39157-3423
US

V. Phone/Fax

Practice location:
  • Phone: 601-346-4586
  • Fax: 601-346-4587
Mailing address:
  • Phone: 601-707-5381
  • Fax: 601-707-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14514
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: