Individual
DR. JOHN WOODY SISTRUNK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
971 LAKELAND DR, SUITE 353, JACKSON, MS 39216-4643
(601) 949-6990
(601) 949-6105
Mailing address
971 LAKELAND DR, SUITE 353, JACKSON, MS 39216-4643
(601) 949-6990
(601) 949-6105
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
15819
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124713
—
MS
Enumeration date
08/03/2006
Last updated
10/21/2010
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