Organization
PRENTISS PRIMARY CARE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAISHANKAR JAGADEESAN MD (PRESIDENT)
(601) 792-3200
Entity
Organization
Contact information
Practice address
959 HWY 42, PRENTISS, MS 39474-1373
(601) 792-3200
(601) 792-3299
Mailing address
PO BOX 1373, PRENTISS, MS 39474-1373
(601) 792-3200
(601) 792-3299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15442
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118344
—
MS
05
—
09016230
—
MS
Enumeration date
03/11/2010
Last updated
03/11/2010
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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