Individual
KORI MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-4644
(601) 200-4645
Mailing address
PO BOX 22727, JACKSON, MS 39225-2727
(601) 200-4644
(601) 200-4645
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0116027608
VA
207R00000X
Internal Medicine Physician
Primary
25441
MS
Other
Enumeration date
08/08/2014
Last updated
07/10/2019
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