Individual
LISA A. DIDION
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) 815-8049
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-8049
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
21717
MS
208000000X
Pediatrics Physician
37785
IA
208000000X
Pediatrics Physician
R-7505
IA
2080A0000X
Pediatric Adolescent Medicine Physician
062331
GA
2080A0000X
Pediatric Adolescent Medicine Physician
37785
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
570427586A
—
GA
Enumeration date
05/21/2007
Last updated
07/21/2022
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