Healthcare Provider Details

I. General information

NPI: 1578542007
Provider Name (Legal Business Name): JEFFREY LOUIS MCGILBRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HIGHWAY 39 NORTH
MERIDIAN MS
39301
US

IV. Provider business mailing address

PO BOX 518
MARION MS
39342
US

V. Phone/Fax

Practice location:
  • Phone: 601-453-5493
  • Fax: 888-735-7202
Mailing address:
  • Phone: 601-646-7700
  • Fax: 601-646-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18633
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: