Healthcare Provider Details

I. General information

NPI: 1225389273
Provider Name (Legal Business Name): JEFFREY L MCGILBRA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2012
Last Update Date: 09/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HIGHWAY 39 N SUITE B
MERIDIAN MS
39301-1021
US

IV. Provider business mailing address

PO BOX 518
MARION MS
39342-0518
US

V. Phone/Fax

Practice location:
  • Phone: 601-453-5493
  • Fax: 601-581-9936
Mailing address:
  • Phone: 601-453-5493
  • Fax: 601-581-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number18633
License Number StateMS

VIII. Authorized Official

Name: DR. JEFFREY MCGILBRA
Title or Position: SOLE MBR
Credential: MD
Phone: 601-453-5493