Individual
SHREYAS GANGADHARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5500
(601) 984-5503
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5500
(601) 984-5503
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
24364
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06101246
—
MS
05
—
06230860
—
MS
Enumeration date
07/04/2011
Last updated
01/03/2017
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