Individual
DR. MIRIAM J. SHATLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
108 BELLE MEADE POINTE, FLOWOOD, MS 39232
(601) 992-7002
Mailing address
107 HERON COVE - FOXBAY, BRANDON, MS 39047-8993
(601) 992-7002
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
14462
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14462
STATE MEDICAL LICENSE ##
MS
Enumeration date
07/13/2006
Last updated
07/09/2007
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