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Individual

JACKSON WALTERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
670 LEIGH DR, COLUMBUS, MS 39705-3014
(662) 328-1012
(662) 328-1507
Mailing address
670 LEIGH DR, COLUMBUS, MS 39705-3014
(662) 328-1012
(662) 328-1507

Taxonomy

Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
22184
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
07800068
MS
Enumeration date
08/14/2008
Last updated
12/09/2019
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