Organization
UPA PLLC CHILD DEV CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OWEN B EVANS M.D. (MANAGER)
(601) 984-5214
Entity
Organization
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5274
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5274
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014110
—
MS
Enumeration date
01/18/2007
Last updated
06/24/2008
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