Shannon Ayiesha Milbourne, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

T-2338 Issued in MS

Practice address

2500 N State St
Department of Radiology
Jackson, MS 39216-4500

Phone

(601) 984-2695

Fax

(601) 984-2683

NPI assigned

Jul 2, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278028800000",
    "number": "1295047561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "address_2": "DEPARTMENT OF RADIOLOGY",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-2695",
            "fax_number": "601-984-2683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "address_2": "DEPARTMENT OF RADIOLOGY",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-2695",
            "fax_number": "601-984-2683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILBOURNE",
        "first_name": "SHANNON",
        "middle_name": "AYIESHA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-02",
        "last_updated": "2010-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MS",
            "license": "T-2338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Middleton, MD
• Steve Middleton
• Romero Keith Midgett, M.D.
• Elisa Miguel-Qin, MD
• Eleni Marie Mijalis
• Richard John Miles, DO
• Milestone Pediatric Medical Center
• Milestone Primary Care House Calls, LLC
• Matthew Paul Miley, DO
• William Brent Miley, CRNA

• Diagnostic Radiology Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Diagnostic Radiology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.