Healthcare Provider Details

I. General information

NPI: 1699716241
Provider Name (Legal Business Name): GERALDINE CHANEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2679 CRANE RIDGE DR SUITE F
JACKSON MS
39216-4997
US

IV. Provider business mailing address

PO BOX 9228
JACKSON MS
39286-9228
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-7476
  • Fax: 601-362-7460
Mailing address:
  • Phone: 601-362-7476
  • Fax: 601-362-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number07969
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: