Provider Demographics
NPI:1558586792
Name:WL ARON MD PA
Entity Type:Organization
Organization Name:WL ARON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LELON
Authorized Official - Last Name:ARON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:601-957-7343
Mailing Address - Street 1:1551 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-1801
Mailing Address - Country:US
Mailing Address - Phone:601-957-7344
Mailing Address - Fax:
Practice Address - Street 1:1551 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-1801
Practice Address - Country:US
Practice Address - Phone:601-957-7344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05950261QM0850X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherBLUE CROSS OF MS