Provider Demographics
NPI:1225389273
Name:JEFFREY L MCGILBRA MD PLLC
Entity Type:Organization
Organization Name:JEFFREY L MCGILBRA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILBRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-453-5493
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MS
Mailing Address - Zip Code:39342-0518
Mailing Address - Country:US
Mailing Address - Phone:601-453-5493
Mailing Address - Fax:601-581-9936
Practice Address - Street 1:5000 HIGHWAY 39 N
Practice Address - Street 2:SUITE B
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1021
Practice Address - Country:US
Practice Address - Phone:601-453-5493
Practice Address - Fax:601-581-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-29
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18633103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty