1407989619 NPI number — DANA LORRAINE-JONES CARBO BRYANT M. D.

Table of content: DANA LORRAINE-JONES CARBO BRYANT M. D. (NPI 1407989619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407989619 NPI number — DANA LORRAINE-JONES CARBO BRYANT M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARBO BRYANT
Provider First Name:
DANA
Provider Middle Name:
LORRAINE-JONES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES CARBO
Provider Other First Name:
DANA
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407989619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
297 HIGHWAY 51 STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGELAND
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39157-3423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-707-5381
Provider Business Mailing Address Fax Number:
601-707-5382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1824 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39204-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-346-4586
Provider Business Practice Location Address Fax Number:
601-346-4587
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  14514 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00115571 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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