Individual
CODY WAYNE CISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
830 S GLOSTER ST, TUPELO, MS 38801-4996
(662) 377-3000
Mailing address
830 S GLOSTER ST, TUPELO, MS 38801-4996
(662) 377-3000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
PENDING
MS
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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