Basic Information
| Provider Information | |||||||||
| NPI: | 1083752612 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FORD | ||||||||
| FirstName: | JOYCELYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1721 SMALLWOOD ST | ||||||||
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| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392122664 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E WOODROW WILSON AVE | ||||||||
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| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392165116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013624471 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246QM0706X | MS | Y | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Pathology | Medical Technologist |
No ID Information.