# PRENTISS PRIMARY CARE, P.A.

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

## Provider details

- **NPI number:** 1902129455
- **Authorized official:** DR. JAISHANKAR JAGADEESAN MD (PRESIDENT)
- **Authorized official phone:** (601) 792-3200

## Contact information

- **Practice address:** 959 HWY 42, PRENTISS, MS 39474-1373
- **Practice address phone:** (601) 792-3200
- **Practice address fax:** (601) 792-3299
- **Mailing address:** PO BOX 1373, PRENTISS, MS 39474-1373
- **Mailing address phone:** (601) 792-3200
- **Mailing address fax:** (601) 792-3299

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 15442 | MS | Yes |

## Other

- **Enumeration date:** 03/11/2010
- **Last updated:** 03/11/2010