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NPI Code Detail

MEDICARE: JESSICA SHANNA JAMES PHD

MEDICARE: JESSICA SHANNA JAMES PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist20043221AIN
2390200000XStudent in an Organized Health Care Education/Training Program
3103TC2200XClinical Child & Adolescent Psychologist

General Provider Information

NPI Number : 1205363447
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SHANNA JAMES PHD
Provider Business Mailing Address
First Line : 32 MILLBRANCH RD STE 40
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-1673
Country : US
Telephone Number : 601-255-5264
Fax Number : 866-625-0559
Provider Business Practice Location Address
First Line : 32 MILLBRANCH RD STE 40
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-1673
Country : US
Telephone Number : 601-255-5264
Fax Number : 866-625-0559
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2017
Last Update Date : 07/21/2022

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