Organization
JACKSON PEDIATRIC ASSOCIATES P A
Active
Parent organization
JACKSON PEDIATRIC ASSOCIATES
Other names
CHADWICK DRIVE CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
JACKSON PEDIATRIC ASSOCIATES
Authorized official
DR. YOLANDA W WILSON M.D. (PRESIDENT)
(601) 707-5381
Entity
Organization
Contact information
Practice address
1824 HOSPITAL DR, JACKSON, MS 39204-3410
(601) 346-4586
(601) 346-4587
Mailing address
297 HIGHWAY 51 STE B, RIDGELAND, MS 39157-3423
(601) 707-5381
(601) 737-5382
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12555
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07325898
—
MS
Enumeration date
01/02/2008
Last updated
11/15/2011
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