Organization
ELLISVILLE STATE SCHOOL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUZIE LASSITER (DIRECTOR)
(601) 477-9384
Entity
Organization
Contact information
Practice address
1101 HWY 11 S, ELLISVILLE, MS 39437-4444
(601) 477-9384
(601) 477-5700
Mailing address
1101 HWY 11 S, ELLISVILLE, MS 39437-4444
(601) 477-9384
(601) 477-5700
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
C00638
MS
Other
Enumeration date
06/21/2005
Last updated
08/22/2020
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