Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 23233 | MS |
N | 204F00000X | Transplant Surgeon | 24126 | GA |
N | 208200000X | Surgeon | 24126 | GA |
N | 208600000X | Surgeon | 24126 | GA |
N | 2086S0129X | Vascular Surgeon | 024126 | GA |
NPI | 1568573228 |
---|---|
Provider Name | James Wynn SR. |
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 | 31/08/2006 |
Last Update Date | 05/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000345364A | (05) | GA |
07888702 | (05) | MS |
D41444 | (02) | |
G24126 | (05) | SC |