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General NPI Number Information
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NPI Number | 1033318985
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Entity Type | Organization
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Legal Business Name | SUNDER JAGWANI MD PA
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 1401 RIVER RD
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City | GREENWOOD
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State | MS
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Zip | 38930-4030
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Country | US
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Telephone | 601-636-0097
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Fax | 601-629-9969
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Provider Business Mailing Address
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Address Line | 1401 RIVER RD
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City | GREENWOOD
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State | MS
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Zip | 38930-4030
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Country | US
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Telephone | 601-636-0097
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Fax | 601-629-9969
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Authorized Official
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Title or Position | PRES
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Name | SUNDER JAGWANI
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Credential | MD
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Telephone | 601-636-0097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 10551
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License Number State | MS
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