Organization
AXON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK WELDON MD (OWNER)
(601) 376-2004
Entity
Organization
Contact information
Practice address
1860 CHADWICK DR STE 258, STE 258, JACKSON, MS 39204-3486
(601) 376-2004
Mailing address
1860 CHADWICK DR, STE 258, JACKSON, MS 39204-3463
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE7025
MEDICARE RAILROAD
MS
Enumeration date
10/18/2006
Last updated
11/02/2011
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