Provider Demographics
NPI:1992789309
Name:OSBORNE, JAN CHANDLER (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:CHANDLER
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:611 ALCORN DRIVE
Mailing Address - Street 2:CROSSROADS CENTER
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9321
Mailing Address - Country:US
Mailing Address - Phone:662-293-4280
Mailing Address - Fax:662-293-4282
Practice Address - Street 1:611 ALCORN DRIVE
Practice Address - Street 2:CROSSROADS CENTER
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9321
Practice Address - Country:US
Practice Address - Phone:662-293-4280
Practice Address - Fax:662-293-4282
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY391232084P0800X
MS217022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87364Medicare UPIN