Individual
MISS MODUPE HARRIET AJISAFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
DEPARTMENT OF FAMILY MEDICINE, 2500 N STATE ST, JACKSON, MS 39216
(601) 984-5426
Mailing address
1855 LAKELAND DR APT 415, JACKSON, MS 39216-0005
(346) 370-2417
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
T5940
MS
Other
Enumeration date
04/16/2025
Last updated
11/05/2025
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