THE PAIN CLINIC OF MISSISSIPPI, PLLC (NPI# 1063786036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063786036 |
| Entity Type | Organization |
| Organization Name | THE PAIN CLINIC OF MISSISSIPPI, PLLC |
| Practice Address |
5903 Ridgewood Rd Suite 440 Jackson MS 39211-3700 |
| Mailing Address |
Po Box 235019 Montgomery AL 36123-5019 |
| Practice Telephone | 6018993989 |
| Practice Fax Number | 6018993504 |
| Mailing Telephone | 8002325703 |
| Mailing Fax Number | 3343954110 |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2012-03-08 |
| Authorized Official Name | DR. DUANE WILLIAMSON (PRESIDENT) |
| Authorized Official Telephone | 6018993989 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5903 RIDGEWOOD RD SUITE 440 |
| City | JACKSON |
| State | MS |
| Zip Code | 39211-3700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255330163 | Select Specialty Hospital - Jackson Inc | Long Term Care Hospital | 5903 Ridgewood Rd, Jackson, MS 39211-3700 | 2005-07-21 |
| 1083079545 | Genevieve Celeste Garrett | Social Worker | 5903 Ridgewood Rd, Jackson, MS 39211-3700 | 2015-12-28 |
| 1528443975 | Medical Assurance LLC | Internal Medicine | 5903 Ridgewood Rd, Suite 320, Jackson, MS 39211-3700 | 2015-07-28 |
| 1255719068 | Medical Care Alliance LLC | Clinic/Center | 5903 Ridgewood Rd, Suite 310, Jackson, MS 39211-3700 | 2015-05-13 |
| 1881087427 | Infusion Center Pharmacy | Clinic/Center | 5903 Ridgewood Rd, Suite 110, Jackson, MS 39211-3700 | 2015-03-06 |
| 1720213069 | Reddix Medical Group | Clinic/Center | 5903 Ridgewood Rd, Suite 310, Jackson, MS 39211-3700 | 2009-05-15 |
| 1154569853 | Leslie Rooks | Registered Nurse | 5903 Ridgewood Rd, Jackson, MS 39211-3700 | 2009-02-03 |
| 1720258403 | Neurosurgical Associates | Neurological Surgery | 5903 Ridgewood Rd, Suite 101, Jackson, MS 39211-3700 | 2008-03-10 |
| 1508036575 | Heart Associates of Central Ms | Internal Medicine | 5903 Ridgewood Rd, Suite230, Jackson, MS 39211-3700 | 2008-03-06 |
| 1841496239 | Howard R Holaday, M.d., P.a. | Neurological Surgery | 5903 Ridgewood Rd, Suite 101, Jackson, MS 39211-3700 | 2007-06-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760092878 | Bio-medical Applications of Mississippi, Inc. | Clinic/Center | 5722 I-55 N Frontage Road, Jackson, MS 39211 | 2020-08-04 |
| 1548881048 | Gloria Dansby-giles | Counselor | 4500 Interstate 55, North; Suite 220, Jackson, MS 39211 | 2020-05-06 |
| 1821628223 | Alice Powell Taylor | St. Dominic Weight Loss Solutions, 3800 Interstate 55 North Frontage Road Suite 102, Jackson, MS 39211 | 2020-01-24 | |
| 1356980643 | Bethany Powers | Pharmacist | 4910 Interstate 55 North Frontage Rd, Jackson, MS 39211 | 2020-01-03 |
| 1316585581 | Deborah Magoun Rosenbaum | Pharmacist | [email protected], 4910 I-55 North, Jackson, MS 39211 | 2019-12-18 |
| 1285108357 | Eric Wood | Counselor | 4623 Maurey Rd, Jackson, MS 39211 | 2019-01-11 |
| 1649758301 | Isluv Robertson | Registered Nurse | 1405 E Northside Dr, Jackson, MS 39211 | 2018-08-03 |
| 1659863066 | Jonbrighton Childs Russell | Student in an Organized Health Care Education/Training Program | 4343 Dalrymple Ct, Jackson, MS 39211 | 2018-05-31 |
| 1225557598 | Regina Ann Day | Dietitian, Registered | 3800 I 55 North Frontage Road, Jackson, MS 39211 | 2017-09-18 |
| 1023558525 | Agilitas Usa Inc | Clinic/Center | 120 District Blvd E, Suite D102, Jackson, MS 39211 | 2017-03-02 |
| Find all providers in zip 39211 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113627 | Jessicah Blasdel | Nurse Practitioner | 113 W Michigan Ave, Jackson, MI 49201-1340 | 2020-10-31 |
| 1801406335 | Jade Russell | Nurse Practitioner | 2205 W Morrell St, Jackson, MI 49203-1357 | 2020-08-10 |
| 1992315212 | Patrecia Campbell | Nurse Practitioner | 2570 Bailey Ave Ste 7, Jackson, MS 39213-6905 | 2020-08-01 |
| 1669008926 | Kristine Edwards | Nurse Practitioner | 723 Woodlawn Ave, Jackson, MI 49203-2921 | 2020-03-19 |
| 1295366391 | Christy White | Nurse Practitioner | 363 Old Pinson Rd, Jackson, TN 38301-9576 | 2020-01-28 |
| 1972141620 | Primary Care - Bemis, LLC | Nurse Practitioner | 1385 S Highland Ave Ste B4, Jackson, TN 38301-7547 | 2019-12-12 |
| 1174164263 | Tami Anne Miller | Nurse Practitioner | 124 N Bast St, Jackson, MO 63755-1704 | 2019-10-01 |
| 1265080584 | Cameron Nicole Howard | Nurse Practitioner | 1860 Chadwick Dr Ste 256, Jackson, MS 39204-3486 | 2019-08-29 |
| 1831750843 | Rhiannon Michelle Andresen | Nurse Practitioner | 1022 Greystone Sq, Jackson, TN 38305-3580 | 2019-06-21 |
| 1902376361 | Jenay B Krumm | Nurse Practitioner | 1201 E Michigan Ave Ste 200, Jackson, MI 49201-1855 | 2018-11-28 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.