MEDICARE: ANTONIO MCCASKILL

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
1	172A00000X	Driver	800757046	MS

General Provider Information

NPI Number	:	1609695022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO MCCASKILL

Provider Business Mailing Address
First Line	:	209 WILDWOOD BLVD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-9618
Country	:	US
Telephone Number	:	601-906-1558
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 WILDWOOD BLVD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-9618
Country	:	US
Telephone Number	:	601-906-1558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	10/03/2024

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Directions to “ ANTONIO MCCASKILL ” Practice Location

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