Provider Demographics
NPI:1518411529
Name:JOHN ELGIN WILKAITIS, MD, MS, PLLC
Entity type:Organization
Organization Name:JOHN ELGIN WILKAITIS, MD, MS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELGIN
Authorized Official - Last Name:WILKAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-829-4170
Mailing Address - Street 1:3531 LAKELAND DR
Mailing Address - Street 2:STE 1052
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8049
Mailing Address - Country:US
Mailing Address - Phone:601-982-8531
Mailing Address - Fax:601-982-1115
Practice Address - Street 1:4500 I 55 N STE 234
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5932
Practice Address - Country:US
Practice Address - Phone:601-982-8531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901668363L00000X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty