Organization
SONNY MONTGOMER VAMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICAH DICKSON TAYLOR LCSW (OUTPATIENT LCSW)
(601) 362-4471
Entity
Organization
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
Mailing address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
Taxonomy
Speciality
Code
Description
License number
State
284300000X
Special Hospital
Primary
C6323
MS
Other
Enumeration date
06/20/2013
Last updated
06/20/2013
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