Individual
MRS. GRACE GORE STURDIVANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-6000
(601) 984-5085
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-6000
(601) 984-5085
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
A3608
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07203769
—
MS
01
—
P01266932
RAILROAD MEDICARE
MS
Enumeration date
03/13/2012
Last updated
03/17/2014
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