Individual
DR. JAISHANKAR JAGADEESAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
972 COLUMBIA AVE, PRENTISS, MS 39474
(601) 792-3200
(601) 792-3299
Mailing address
PO BOX 1373, PRENTISS, MS 39474-1373
(601) 792-3200
(601) 792-3299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15442
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016230
—
MS
Enumeration date
09/25/2006
Last updated
03/07/2023
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