Provider Demographics
NPI:1700375821
Name:VYAS, KSHAMA J (MD)
Entity Type:Individual
Prefix:DR
First Name:KSHAMA
Middle Name:J
Last Name:VYAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-815-5700
Mailing Address - Fax:601-815-5795
Practice Address - Street 1:2466 FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-815-5700
Practice Address - Fax:601-815-5795
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2019-01-24
Deactivation Date:2018-12-19
Deactivation Code:
Reactivation Date:2019-01-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program