Provider Demographics
NPI:1942231543
Name:JACKSON NEUROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:JACKSON NEUROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIWARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-981-0034
Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:SUITE 1151
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-981-0034
Mailing Address - Fax:601-981-0099
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 1151
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-981-0034
Practice Address - Fax:601-981-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06921064Medicaid
MS=========OtherBCBS
E91891Medicare UPIN