Organization
VICKSBURG NEPHROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL L DAVIS MD (OWNER)
(601) 738-5549
Entity
Organization
Contact information
Practice address
104 MCAULEY DR, VICKSBURG, MS 39183-2825
(601) 738-5549
(601) 630-9120
Mailing address
PO BOX 820663, VICKSBURG, MS 39182-0663
(601) 738-5549
(601) 630-9120
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
04/22/2014
Last updated
04/22/2014
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