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Organization
MISSISSIPPI RETINA ASSOCIATES,PLLC
Active
Organization
MISSISSIPPI RETINA ASSOCIATES,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JUDE BORNE (PRESIDENT)
(601) 981-4091
Entity
Organization
Contact information
Practice address
1026 BAPTIST CIR STE 400, MADISON, MS 39110-2028
(601) 981-4091
(601) 981-5039
Mailing address
1200 N STATE ST, SUITE 300, JACKSON, MS 39202-2001
(601) 981-4091
(601) 981-5039
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
MS
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014141
—
MS
01
—
CA5305
RAILROAD MEDICARE
MS
Enumeration date
11/29/2006
Last updated
01/23/2025
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