Healthcare Provider Details

I. General information

NPI: 1851405369
Provider Name (Legal Business Name): SHANKAR PRAHARAJU GIRIJA GIRI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: G. SHANKAR GIRI M.D.

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET UNIVERSITY OF MS MEDICAL CENTER-RADIATION ONCOLOGY
JACKSON MS
39216-4505
US

IV. Provider business mailing address

2500 NORTH STATE STREET UNIVERSITY OF MISSISSIPPI MEDICAL CENTER -RADIATION ONC
JACKSON MS
39216-4505
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-7652
  • Fax: 601-815-6876
Mailing address:
  • Phone: 601-815-7652
  • Fax: 601-815-6876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101031794
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberR7A15
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number21834
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: