Individual
BEVERLY GWEN WINDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE DIVISION OF GERIATRICS, JACKSON, MS 39216
(601) 984-5610
(601) 984-5783
Mailing address
2500 N STATE ST, DIVISION OF GERIATRICS, JACKSON, MS 39216-4500
(601) 984-5610
(601) 984-5783
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
D0056056
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08952891
—
MS
Enumeration date
11/30/2006
Last updated
04/11/2014
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