Jaisiri Jaiwatana, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD9250 Issued in DC

Practice address

1500 E. Woodrow Wilson Drive
Jackson, MS 39216-5199

Phone

(601) 362-4471

Fax

(601) 364-1588

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

No

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295760049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E. WOODROW WILSON DRIVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165199",
            "telephone_number": "601-362-4471",
            "fax_number": "601-364-1588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E. WOODROW WILSON DRIVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165199",
            "telephone_number": "601-362-4471",
            "fax_number": "601-364-1588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIWATANA",
        "first_name": "JAISIRI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "DC",
            "license": "MD9250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Jackson, MS
• Providers in Jackson, MS by specialty
• Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.