Upa Pllc Adolescent Med
NPI #1205953809 in Jackson, Mississippi
Provider Information
- NPI Number
- 1205953809
- Entity Type
- Organization
- Organization Name
- Upa Pllc Adolescent Med
- Primary Specialty
- Pediatrics - Adolescent Medicine
- Enumeration Date
- Mar 26, 2007
- Last Updated
- Jun 24, 2008
Practice Location
- Address
- 2500 N STATE ST
- City
- Jackson
- State
- Mississippi
- ZIP Code
- 39216-4500
- Phone
- (601) 984-5236
Authorized Official
- Name
- OWEN B EVANS, M.D.
- Title
- MANAGING EMPLOYEE
- Phone
- (601) 984-5214
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pediatrics - Adolescent Medicine — Adolescent Medicine |
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