# SUNDER JAGWANI MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033318985
- **Authorized official:** SUNDER JAGWANI MD (PRES)
- **Authorized official phone:** (601) 636-0097

## Contact information

- **Practice address:** 1401 RIVER RD, GREENWOOD, MS 38930-4030
- **Practice address phone:** (601) 636-0097
- **Practice address fax:** (601) 629-9969
- **Mailing address:** 1401 RIVER RD, GREENWOOD, MS 38930-4030
- **Mailing address phone:** (601) 636-0097
- **Mailing address fax:** (601) 629-9969

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085B0100X | Body Imaging Physician | 10551 | MS | Yes |

## Other

- **Enumeration date:** 07/12/2007
- **Last updated:** 05/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 08707229 | — | MS |