NPIMap

Organization Active NPI

Clinical Neuroscience Group, PLLC

  • Psychiatry Physician
  • Flowood, MS
National Provider Identifier
1710175260
Registry record updated Oct 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
CLINICAL NEUROSCIENCE GROUP, PLLC
Practice address
3531 Lakeland Dr
Suite 1058
Flowood, MS 39232-8049
Phone
(601) 420-7010
NPI assigned
Oct 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2007

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

Authorized official

Name
Dr. John Elgin Wilkaitis, M.D., M.S.NPI 1154360824
Title
President
Phone
(601) 420-7010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

3531 Lakeland Dr
Suite 1058
Flowood, MS 39232-8049

Mailing address

3531 Lakeland Dr
Suite 1058
Flowood, MS 39232-8049
Phone (601) 420-7010

National Provider Directory

National Provider Directory

Locations

3531 Lakeland Dr
Ste 1058
Jackson, MS 39232
Phone (601) 420-7010

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1710175260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3531 LAKELAND DR",
            "address_2": "SUITE 1058",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392328049",
            "telephone_number": "601-420-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3531 LAKELAND DR",
            "address_2": "SUITE 1058",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392328049",
            "telephone_number": "601-420-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL NEUROSCIENCE GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-10",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "WILKAITIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ELGIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-420-7010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., M.S."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.