# GULF STATES PHYSICAL MEDICINE & REHABILITATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033271416
- **Authorized official:** AMY GRISSETT (MANAGER)
- **Authorized official phone:** (601) 944-1717

## Contact information

- **Practice address:** 1190 N STATE ST, SUITE 202, JACKSON, MS 39202-2413
- **Practice address phone:** (601) 968-0894
- **Practice address fax:** (601) 968-0896
- **Mailing address:** 1190 N STATE ST, SUITE 202, JACKSON, MS 39202-2413
- **Mailing address phone:** (601) 968-0894
- **Mailing address fax:** (601) 968-0896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | MS | Yes |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 01/13/2015