Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 407 | NM |
N | 103TC0700X | Clinical Psychologist | 407 | NM |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | T55973 | MS |
NPI | 1053327759 |
---|---|
Provider Name | Dr. Robert D Annett |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 16/12/2015 |