Ear Nose and Throat Surgical Group
NPI #1699810069 in Jackson, Mississippi
Provider Information
- NPI Number
- 1699810069
- Entity Type
- Organization
- Organization Name
- Ear Nose and Throat Surgical Group
- Primary Specialty
- Specialist
- Enumeration Date
- Feb 21, 2007
- Last Updated
- Aug 10, 2011
Practice Location
- Address
- 970 LAKELAND DR STE 40
- City
- Jackson
- State
- Mississippi
- ZIP Code
- 39216-4640
- Phone
- (601) 200-4850
Authorized Official
- Name
- MICKEY P WALLACE, MD
- Title
- PHYSICIAN
- Phone
- (601) 898-7000
Specialties & Taxonomy Codes
| Specialty |
|---|
| Specialist |
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