Individual
JAISIRI JAIWATANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 E. WOODROW WILSON DRIVE, JACKSON, MS 39216-5199
(601) 362-4471
(601) 364-1588
Mailing address
1500 E. WOODROW WILSON DRIVE, JACKSON, MS 39216-5199
(601) 362-4471
(601) 364-1588
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD9250
DC
Other
Enumeration date
07/11/2006
Last updated
07/08/2007
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