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General NPI Number Information
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NPI Number | 1629378971
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Entity Type | Organization
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Legal Business Name | JACKSON PSYCHIATRY GROUP
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 201 NORTHLAKE AVE STE 207
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City | RIDGELAND
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State | MS
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Zip | 39157-1715
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Country | US
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Telephone | 601-366-4696
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Fax | 601-414-9486
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Provider Business Mailing Address
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Address Line | 201 NORTHLAKE AVE STE 207
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City | RIDGELAND
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State | MS
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Zip | 39157-1715
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Country | US
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Telephone | 601-366-4696
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Fax | 601-414-9486
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS W BYRD
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Credential | MD
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Telephone | 601-366-4696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 15999
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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