Individual
DR. MARILYN DAVIDSON GRAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-7554
(601) 815-3226
Mailing address
4035 OAKRIDGE DR, JACKSON, MS 39216-3414
(601) 815-7554
(601) 815-3226
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
05990
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014881
—
MS
Enumeration date
06/04/2007
Last updated
07/08/2007
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