Individual
JUSTIN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
427 HIGHWAY 51 N, BROOKHAVEN, MS 39601-2350
(601) 835-9275
(888) 965-6812
Mailing address
427 HIGHWAY 51 N, BROOKHAVEN, MS 39601-2350
(601) 835-9275
(888) 965-6812
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
854447
MS
Other
Enumeration date
01/13/2020
Last updated
01/13/2020
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