Individual
DR. CHARLES CHRISTIAN PAINE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6562
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6562
(601) 815-6106
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
T-2375
MS
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
22788
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03759341
—
MS
Enumeration date
07/02/2010
Last updated
10/03/2018
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