Organization · Type 2 NPI
Physician Practice of Madison, PC
Specialist · Vicksburg, MS
NPI number
1114476389
Active
Practice location
1111 N Frontage Rd Fl 2
Vicksburg, MS 39180-5102
Fax (601) 510-2367
Mailing address
6 Eastbrooke Cir
Madison, MS 39110-6537
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Specialist Primary | 174400000X | 21500 (MS) |
Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Other specialist providers in Vicksburg
About NPI 1114476389
Physician Practice of Madison, PC's National Provider Identifier is 1114476389, issued on Sep 28, 2016. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Vicksburg, MS. The record was last updated on Sep 28, 2016.