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Individual

MR. JIMMY LEE STEWART JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2500 NORTH STATE STREET, DEPT OF MEDICINE DIVISION OF HYPERTENSION, JACKSON, MS 39216-4500
(601) 984-6850
(601) 984-6853
Mailing address
2500 NORTH STATE STREET, HYPERTENSION, JACKSON, MS 39216-4500
(601) 984-6850
(601) 984-6853

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16401
MS
208000000X
Pediatrics Physician
16401
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00121927
MS
05
1133515
LA
01
P00393117
RR MEDICARE - GROUP CN0867
MS
Enumeration date
06/22/2006
Last updated
04/09/2014
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