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Contact Information

JACKSON PSYCHIATRY GROUP
201 NORTHLAKE AVE STE 207
RIDGELAND, MS39157-1715
 Phone: 601-366-4696
 Fax: 601-414-9486
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Prescribing (Medical)

103TP0016X 62 Psychologist, Clinical
 

Psychiatric/Mental Health

363LP0808X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for JACKSON PSYCHIATRY GROUP · (Female)

NPI Number 1629378971
Status Active
Credentials
Entity Individual
Enumeration date 11/02/2010
Last updated 06/19/2025 - About 12 months ago
Sole proprietor 1 Not specified
Identifiers
  • MS License # 15999
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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