Provider Demographics
NPI:1245338441
Name:THOMAS-TAYLOR, JENNIFER ANITRA (MD ,MPH)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANITRA
Last Name:THOMAS-TAYLOR
Suffix:
Gender:F
Credentials:MD ,MPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-8874
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:4105 HOSPITAL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5312
Practice Address - Country:US
Practice Address - Phone:228-696-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012403282084P0800X
MS228122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry