Healthcare Provider Details

I. General information

NPI: 1821291790
Provider Name (Legal Business Name): MARGARET E WADSWORTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLOTTE EDWARDS MD

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

970 LAKELAND DR SUITE 34
JACKSON MS
39216-4635
US

V. Phone/Fax

Practice location:
  • Phone: 601-968-1416
  • Fax: 601-968-1218
Mailing address:
  • Phone: 601-362-0600
  • Fax: 601-362-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number21013
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: