Individual
DR. VIVIAN ELIZABETH 'LISA' HUDDLESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1405 STRONG AVE, GREENWOOD, MS 38930-4035
(662) 459-7030
Mailing address
PO BOX 1410, ATTN: CLINIC ADMINISTRATION, GREENWOOD, MS 38935-1410
(662) 459-7285
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
18482
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06771370
—
MS
Enumeration date
03/17/2006
Last updated
08/20/2019
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