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General NPI Number Information
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NPI Number | 1417314865
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Entity Type | Organization
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Legal Business Name | JACKSON NEUROSCIENCE CENTER
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Dates
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Enumeration Date | 01/15/2016
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 207 W JACKSON ST SUITE 1
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City | RIDGELAND
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State | MS
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Zip | 39157-2355
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Country | US
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Telephone | 601-992-5943
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Fax | 601-992-9152
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Provider Business Mailing Address
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Address Line | 207 W JACKSON ST SUITE 1
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City | RIDGELAND
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State | MS
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Zip | 39157-2355
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Country | US
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Telephone | 601-992-5943
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Fax | 601-992-9152
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Authorized Official
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Title or Position | MGR
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Name | RON MILONE
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Credential |
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Telephone | 601-992-5943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 16393
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License Number State | MS
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