Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2006-07-07
- Last updated
- 2020-12-30
Licenses
- License MS
- 17806
- License MS
- 17806
Location
- Practice location
- 310 ELLIS ST
- City
- CARTHAGE MS
- Postal code
- 390513809
- Phone
- 601-740-2785
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.