UNIVERSITY NEUROLOGY GROUP, PLLC
Clinical Neuropsychologist
Jackson, Mississippi
Provider NPI: 1770599110
Organization Information:Organization Name: UNIVERSITY NEUROLOGY GROUP, PLLC
Organization is not Subpart
Authorized Official: JAMES J. CORBETT CHAIR AND MANAGING PARTNER 601-9845500
Practice Location:
2500 NORTH STATE STREET JACKSON, MS 39216 US
Tel: 601-984-5500 Fax: 601-984-5499
Business Mailing Address:
PO BOX 4528 JACKSON, MS 39296 US
Tel: 601-984-5500 Fax: 601-984-5499
Entity Type: Organization
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Organization is not Subpart
Authorized Official: JAMES J. CORBETT CHAIR AND MANAGING PARTNER 601-9845500
Practice Location:
2500 NORTH STATE STREET JACKSON, MS 39216 US
Tel: 601-984-5500 Fax: 601-984-5499
Business Mailing Address:
PO BOX 4528 JACKSON, MS 39296 US
Tel: 601-984-5500 Fax: 601-984-5499
Entity Type: Organization
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 103G00000X | Behavioral Health & Social Service Providers Clinical Neuropsychologist | ||
Y | 2084N0400X | Physicians Psychiatry & Neurology |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
9012340 | MS | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin