Organization
JACKSON PEDIATRIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YOLANDA W WILSON M. D. (PRESIDENT CEO)
(601) 707-5381
Entity
Organization
Contact information
Practice address
297 HIGHWAY 51 STE B, RIDGELAND, MS 39157-3423
(601) 707-5381
(601) 707-5382
Mailing address
297 HIGHWAY 51 STE B, RIDGELAND, MS 39157-3423
(601) 707-5381
(601) 707-5382
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12555
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015867
—
MS
Enumeration date
03/14/2007
Last updated
11/16/2011
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