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Organization
PRENTISS PRIMARY CARE, P.A.
Active
Organization
PRENTISS PRIMARY CARE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAISHANKAR JAGADEESAN MD (PRESIDENT)
(601) 792-3200
Entity
Organization
Contact information
Practice address
959 HWY 42, PRENTISS, MS 39474-1373
(601) 792-3200
(601) 792-3299
Mailing address
PO BOX 1373, PRENTISS, MS 39474-1373
(601) 792-3200
(601) 792-3299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15442
MS
Other
Enumeration date
03/11/2010
Last updated
03/11/2010
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