Individual
SHANNON AYIESHA MILBOURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, DEPARTMENT OF RADIOLOGY, JACKSON, MS 39216-4500
(601) 984-2695
(601) 984-2683
Mailing address
2500 N STATE ST, DEPARTMENT OF RADIOLOGY, JACKSON, MS 39216-4500
(601) 984-2695
(601) 984-2683
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
T-2338
MS
Other
Enumeration date
07/02/2010
Last updated
07/02/2010
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