Individual
DR. GRACE ELLEN M SANTA TERESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-4000
Mailing address
201 BINNACLE CT, BRANDON, MS 39047-7051
(601) 213-8633
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
659-L
MS
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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