Healthcare Provider Details

I. General information

NPI: 1598687014
Provider Name (Legal Business Name): MILESTONE PEDIATRIC MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4753 MCWILLIE DR
JACKSON MS
39206-5605
US

IV. Provider business mailing address

PO BOX 3263
RIDGELAND MS
39158-3263
US

V. Phone/Fax

Practice location:
  • Phone: 601-291-9285
  • Fax:
Mailing address:
  • Phone: 601-291-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: LAHILLARIE CHRISTON
Title or Position: OWNER/ADMIN
Credential:
Phone: 601-291-9285