DR. JOHN ELGIN WILKAITIS (NPI# 1154360824) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154360824 |
| Entity Type | Individual |
| Full Name | DR. JOHN ELGIN WILKAITIS |
| Credential | M.D.,M.B.A., M.S. |
| Practice Address |
4500 Interstate 55 Frontage Road N Suite 234 Jackson MS 39211-5931 |
| Mailing Address |
3531 Lakeland Dr Complex B Suite 1052 Flowood MS 39232-8049 |
| Practice Telephone | 6019828531 |
| Practice Fax Number | 8887357202 |
| Mailing Telephone | 6019397990 |
| Mailing Fax Number | 6019397254 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2019-02-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
17435 | MS | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
2005021711 | MO | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
17435 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | BLUE CROSS | $$$$$$$$$ | 01 |
| MS | 03932074 | 05 | |
| MO | 207430414 | 05 |
| Street Address |
4500 INTERSTATE 55 FRONTAGE ROAD N SUITE 234 |
| City | JACKSON |
| State | MS |
| Zip Code | 39211-5931 |
| 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 | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144512674 | Magalie Saint-lot Jacques | Psychiatry & Neurology | 31 Bridgewater Ct, Jackson, NJ 08527-4030 | 2011-05-03 |
| 1841337656 | Cynthia Lufkin Undesser | Psychiatry & Neurology | 402 Wesley Ave, Jackson, MS 39202-1000 | 2007-01-31 |
| 1992047682 | Nils Charles Westfall | Psychiatry & Neurology | 555 E Broadway Ave Ste 204, Jackson, WY 83001-8640 | 2013-03-21 |
| 1922372697 | Integrated Family Services, Pllc | Psychiatry & Neurology | 9486 Nc Hwy 305, Jackson, NC 27845-9679 | 2012-02-28 |
| 1548357643 | Scott Rodgers | Psychiatry & Neurology | 2500 N State St, Jackson, MS 39216-4500 | 2006-10-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649466954 | Nazmul Talukdar | Psychiatry & Neurology | 110 Patton Ave, Hattiesburg, MS 39401-6155 | 2007-09-20 |
| 1932321742 | Otis Anderson IIi | Psychiatry & Neurology | 5185 Getwell Rd, Southaven, MS 38671-9691 | 2007-05-02 |
| 1770609364 | Gerri L Hill Chance | Psychiatry & Neurology | 206 Robert Mcdaniel Drive, Hazelhurst, MS 39083 | 2007-03-22 |
| 1932290392 | Millcreek Epsdt | Psychiatry & Neurology | 900 First Ave., N.e., Magee, MS 39111 | 2006-09-28 |
| 1639620560 | North Plantation | Psychiatry & Neurology | 1613 23rd Avenue, Gulfport, MS 39501 | 2016-10-15 |
| 1023363173 | Kelechi Nnamdi Emereonye | Psychiatry & Neurology | 4100 Mamie St, Hattiesburg, MS 39402-1735 | 2012-07-16 |
| 1710175260 | Clinical Neuroscience Group, Pllc | Psychiatry & Neurology | 3531 Lakeland Dr, Suite 1058, Flowood, MS 39232-8049 | 2007-10-10 |
| 1992906598 | Maecenas Inc | Psychiatry & Neurology | 206 Robert Mcdaniel Drive, Hazlehurst, MS 39083-0146 | 2007-05-30 |
| 1154477453 | Anthony Wade Jackson Sr. | Psychiatry & Neurology | 152 Highway 7 S, Oxford, MS 38655-5392 | 2007-01-27 |
| 1073684940 | Timothy Summers | Psychiatry & Neurology | 1818 College Drive, Meridian, MS 39307-5429 | 2006-11-13 |
| Find all providers with the same taxonomy | ||||
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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.