OrganizationEast Lakeland Ob Gyn Associates, P.A.Obstetrics & GynecologyAllopathic & Osteopathic PhysiciansPractice Address1020 River Oaks Dr, Suite 320, Jackson, MS 39232-9500(601) 936-1400PECOS EnrollmentBased on the most recent information from CMS, provider East Lakeland Ob Gyn Associates, P.A. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1235220112Provider TypeOrganizationFull NameEast Lakeland Ob Gyn Associates, P.A.SubpartNoEnumeration Date9/27/2006Last Updated5/27/2008Contact InformationPractice LocationPractice Address1020 River Oaks Dr, Suite 320, Jackson, MS 39232-9500Phone(601) 936-1400Fax(601) 936-0671Mailing LocationMailing Address1020 River Oaks Dr, Suite 320, Jackson, MS 39232-9500Phone(601) 936-1400Fax(601) 936-0671Authorized OfficialNameMcmillan, Beverly Ann (President)Phone(601) 936-1400Provider TaxonomiesCodeDescriptionLicenseCode207V00000XPrimaryDescriptionObstetrics & GynecologyAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID9013604DescriptionMedicaidIssuerUnlistedMississippi