Individual
DR. JUSTIN BLAKE DANIELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
103 BRIGHTON LN, APT/SUITE, RIDGELAND, MS 39157-8775
(601) 421-9943
Mailing address
103 BRIGHTON LN, APT/SUITE, RIDGELAND, MS 39157-8775
(601) 421-9943
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
21838
MS
207P00000X
Emergency Medicine Physician
Primary
T-2302
MS
Other
Enumeration date
07/01/2010
Last updated
06/23/2013
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