Individual
DR. NANCY GRANT WAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2000
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2000
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
12239
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00013243
—
MS
05
—
156929
—
AL
05
—
1656640
—
LA
Enumeration date
06/12/2006
Last updated
03/11/2014
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