Individual
JULIE P WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3000 OLD CANTON RD STE 430, JACKSON, MS 39216
(601) 982-5441
(601) 982-5442
Mailing address
3000 OLD CANTON RD STE 430, JACKSON, MS 39216-4225
(601) 982-5441
(601) 815-6613
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
20645
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08655862
—
MS
01
—
P00781089
RR MEDICARE
—
01
—
P01193355
RAILROAD MEDICARE PTAN
MS
Enumeration date
05/02/2007
Last updated
08/30/2018
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