Healthcare Provider Details

I. General information

NPI: 1023451309
Provider Name (Legal Business Name): JAHANZEB KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 08/11/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

504 CLINTON CETER DRIVE CBO - STE. 4300
CLINTON MS
39056-5610
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-1000
  • Fax: 601-815-0434
Mailing address:
  • Phone: 601-496-9413
  • Fax: 601-815-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26674
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number26674
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: