Provider Demographics
NPI:1831270560
Name:AXON
Entity type:Organization
Organization Name:AXON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-376-2004
Mailing Address - Street 1:1860 CHADWICK DR
Mailing Address - Street 2:STE 258
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1860 CHADWICK DR STE 258
Practice Address - Street 2:STE 258
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3486
Practice Address - Country:US
Practice Address - Phone:601-376-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSDE7025OtherMEDICARE RAILROAD
MSC03339Medicare PIN