Individual
DR. DERECK DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 N STATE ST, JACKSON, MS 39216-4301
(601) 984-5220
(601) 984-5279
Mailing address
2600 N STATE ST, JACKSON, MS 39216-4301
(601) 984-5220
(601) 984-5279
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
18418
MS
208000000X
Pediatrics Physician
2007-00180
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02170804
—
MS
Enumeration date
06/15/2006
Last updated
08/11/2014
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