Individual
JAMES WYNN SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5100
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-3135
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
23233
MS
204F00000X
Transplant Surgery Physician
24126
GA
208600000X
Surgery Physician
24126
GA
2086S0129X
Vascular Surgery Physician
024126
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000345364A
—
GA
05
—
07888702
—
MS
05
—
G24126
—
SC
Enumeration date
08/31/2006
Last updated
08/05/2015
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