Provider Demographics
NPI:1790087393
Name:JACKSON PSYCHIATRY GROUP
Entity Type:Organization
Organization Name:JACKSON PSYCHIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:W
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-366-4696
Mailing Address - Street 1:1855 LAKELAND DR
Mailing Address - Street 2:SUITE P121
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4913
Mailing Address - Country:US
Mailing Address - Phone:601-366-4696
Mailing Address - Fax:866-772-1223
Practice Address - Street 1:1855 LAKELAND DR
Practice Address - Street 2:SUITE P121
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4913
Practice Address - Country:US
Practice Address - Phone:601-366-4696
Practice Address - Fax:866-772-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15999103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty