Individual
MR. EMMANUEL DELASE AGBETI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2500 NORTH STATE STREET, JACKSON, MS 39216
(601) 984-5426
Mailing address
2500 NORTH STATE STREET, JACKSON, MS 39216
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
T-5939
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2025
Last updated
08/14/2025
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