Individual
DR. HEATHER ALICIA HANCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5020
(601) 984-5042
Mailing address
310 DOVER LN, MADISON, MS 39110-9418
(901) 491-9952
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
43457
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821120072
NPI
—
01
—
3001559
MEDICARE PTAN
TN
05
—
3001559
—
TN
01
—
P00864517
RAILROAD MEDICARE
MS
Enumeration date
03/12/2007
Last updated
01/19/2017
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