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Organization
JACKSON NEUROSCIENCE CENTER
Active
Organization
JACKSON NEUROSCIENCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RON MILONE (MGR)
(601) 992-5943
Entity
Organization
Contact information
Practice address
207 W JACKSON ST, SUITE 1, RIDGELAND, MS 39157-2355
(601) 992-5943
(601) 992-9152
Mailing address
207 W JACKSON ST, SUITE 1, RIDGELAND, MS 39157-2355
(601) 992-5943
(601) 992-9152
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
16393
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118254
—
MS
01
—
G50211
UPIN
MS
Enumeration date
01/15/2016
Last updated
01/15/2016
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