Organization
JACKSON NEUROCARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RUTH KELLUM FREDERICKS M.D. (OWNER)
(601) 939-0361
Entity
Organization
Contact information
Practice address
971 LAKELAND DRIVE, SUITE 557, WEST TOWER, JACKSON, MS 39216-4607
(601) 939-0361
(601) 939-5210
Mailing address
971 LAKELAND DRIVE, SUITE 557, WEST TOWER, JACKSON, MS 39216-4607
(601) 939-0361
(601) 939-5210
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
11722
MS
Other
Enumeration date
10/21/2014
Last updated
10/21/2014
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