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General NPI Number Information
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NPI Number | 1154360824
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Entity Type | Individual
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Provider Name | JOHN ELGIN WILKAITIS M.D.,M.B.A., M.S.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 4500 INTERSTATE 55 FRONTAGE ROAD N SUITE 234
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City | JACKSON
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State | MS
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Zip | 39211-5931
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Country | US
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Telephone | 601-982-8531
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Fax | 888-735-7202
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Provider Business Mailing Address
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Address Line | 70 GRANDVIEW CIR
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City | BRANDON
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State | MS
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Zip | 39047-7398
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Country | US
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Telephone | 601-829-4170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 17435
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2005021711
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 17435
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License Number State | MS
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