Individual
GERALD MCKINNEY
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) 815-1800
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
21249
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05105897
—
MS
05
—
2418235
—
OH
05
—
3004265000
—
WV
05
—
64066400
—
KY
01
—
P01532540
RAILROAD MEDICARE PTAN
MS
Enumeration date
03/23/2006
Last updated
12/01/2015
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