Individual
SHANTWANA TASHUN PATTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 GRANITE WAY, VICKSBURG, MS 39183-6952
(662) 299-1888
Mailing address
111 GRANITE WAY, VICKSBURG, MS 39183-6952
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
915953
MS
Other
Enumeration date
01/26/2026
Last updated
01/26/2026
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