Healthcare Provider Details

I. General information

NPI: 1861565293
Provider Name (Legal Business Name): DANIEL TODD HANKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET
JACKSON MS
39216
US

IV. Provider business mailing address

2500 NORTH STATE STREET
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-2538
  • Fax: 601-815-1854
Mailing address:
  • Phone: 601-984-2538
  • Fax: 601-815-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2023-1354
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number26934
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21094
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: