Individual
LISA D FAIRCHILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
(601) 883-5000
Mailing address
2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
(601) 883-5000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
16733
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123219
—
MS
05
—
1484041
—
LA
01
—
7004163
AETNA
MS
Enumeration date
06/18/2006
Last updated
09/10/2020
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