Provider Demographics
NPI:1568563385
Name:ADKINS, JONATHAN ROSS (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ROSS
Last Name:ADKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 LAKELAND DRIVE
Mailing Address - Street 2:SUITE 1460
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4684
Mailing Address - Country:US
Mailing Address - Phone:601-982-3202
Mailing Address - Fax:601-982-3259
Practice Address - Street 1:971 LAKELAND DRIVE
Practice Address - Street 2:SUITE 1460
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4684
Practice Address - Country:US
Practice Address - Phone:601-982-3202
Practice Address - Fax:601-982-3259
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3841208600000X
MS19862208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06902563Medicaid
5121020010OtherMEDICARE PTAN
5121020010OtherMEDICARE PTAN
MS06902563Medicaid