Organization
JEA SURGICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE HUMPHRIES (PRACTICE ADMINISTRATOR)
(601) 353-2020
Entity
Organization
Contact information
Practice address
1026 BAPTIST CIRCLE, SUITE 101, MADISON, MS 39110
(601) 353-2020
Mailing address
1026 BAPTIST CIR STE 101, MADISON, MS 39110-2028
(601) 353-2020
(769) 567-1069
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
01/08/2024
Last updated
06/13/2025
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