Provider Demographics
NPI:1225180938
Name:SCOGGIN, JOE C SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:C
Last Name:SCOGGIN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:C
Other - Last Name:SCOGGIN
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:1675 LAKELAND DRIVE
Mailing Address - Street 2:200 RIVERHILL TOWER
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4852
Mailing Address - Country:US
Mailing Address - Phone:601-362-5468
Mailing Address - Fax:
Practice Address - Street 1:1675 LAKELAND DRIVE
Practice Address - Street 2:200 RIVERHILL TOWER
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4852
Practice Address - Country:US
Practice Address - Phone:601-362-5468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS042422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry