Active NPI
Andres G Viana, PH.D
- Clinical Child & Adolescent Psychologist
- Jackson, MS
National Provider Identifier
1316290067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 52908
- Practice address
- 2500 N State St
Dept of Psychiatry
Jackson, MS 39216-4500 - Phone
- (601) 984-5855
- Fax
- (601) 984-5857
- NPI assigned
- Oct 18, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 52908 | MS | Primary |
Addresses
Primary practice location
2500 N State St
Dept of Psychiatry
Jackson, MS 39216-4500
Mailing address
2500 N State St
University of Mississippi Medical Center
Jackson, MS 39216-4500
Phone (601) 984-5855
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06073391 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52908 | MS | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359417600000",
"number": "1316290067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 N STATE ST",
"address_2": "UNIVERSITY OF MISSISSIPPI MEDICAL CENTER",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164500",
"telephone_number": "601-984-5855",
"fax_number": "601-984-5857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 N STATE ST",
"address_2": "DEPT OF PSYCHIATRY",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164500",
"telephone_number": "601-984-5855",
"fax_number": "601-984-5857"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIANA",
"first_name": "ANDRES",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-10-18",
"last_updated": "2013-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MS",
"license": "52908",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06073391",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.