Individual
JOHN CLARK HENEGAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5616
(601) 984-5689
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5616
(601) 984-5689
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
22684
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02433543
—
MS
Enumeration date
06/19/2008
Last updated
08/23/2016
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