Individual
MARIANNE KERUT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1200 N STATE ST STE 500, JACKSON, MS 39202-2027
(601) 352-2273
(601) 714-3215
Mailing address
965 RIDGE LAKE BLVD STE 315, MEMPHIS, TN 38120-9401
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD52250
SC
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
30043
MS
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
52250
SC
Other
Enumeration date
04/20/2015
Last updated
08/05/2022
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