Organization
UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Active
Other names
UMMC
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH GRAN (CEO FOR UNIVERSITY PHYSICIAN)
(601) 815-4775
Entity
Organization
Contact information
Practice address
2500 N STATE ST # H819-01, JACKSON, MS 39216-4500
(601) 984-5957
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5957
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
22061
CA
103TC1900X
Counseling Psychologist
Primary
49850
MS
Other
Enumeration date
12/17/2009
Last updated
10/25/2010
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