Organization
GULF STATES PHYSICAL MEDICINE & REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY GRISSETT (MANAGER)
(601) 944-1717
Entity
Organization
Contact information
Practice address
1190 N STATE ST, SUITE 202, JACKSON, MS 39202-2413
(601) 968-0894
(601) 968-0896
Mailing address
1190 N STATE ST, SUITE 202, JACKSON, MS 39202-2413
(601) 968-0894
(601) 968-0896
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
MS
Other
Enumeration date
12/14/2006
Last updated
01/13/2015
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