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Individual

AUDREY UKACHI ROBERTSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
514H E WOODROW WILSON AVE, JACKSON, MS 39216-4538
(601) 713-3900
(601) 713-3970
Mailing address
514H E WOODROW WILSON AVE, JACKSON, MS 39216-4538
(601) 713-3900
(601) 713-3970

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
15656
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00118818
MS
01
001819211003
UNITED HEALTH CARE
MS
01
5355653
AETNA
MS
Enumeration date
10/05/2006
Last updated
07/08/2007
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