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Organization

CLINICAL NEUROSCIENCE GROUP, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN ELGIN WILKAITIS M.D., M.S. (PRESIDENT)
(601) 420-7010
Entity
Organization

Contact information

Practice address
3531 LAKELAND DR, SUITE 1058, FLOWOOD, MS 39232-8049
(601) 420-7010
Mailing address
3531 LAKELAND DR, SUITE 1058, FLOWOOD, MS 39232-8049
(601) 420-7010

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2084P0804X
Child & Adolescent Psychiatry Physician

Other

Enumeration date
10/10/2007
Last updated
10/10/2007
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