Individual
SUSAN JENAY NEELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
209 E JEFFERSON AVE, GREENWOOD, MS 38930-3649
(662) 392-8163
(601) 944-9780
Mailing address
PO BOX 10389, GREENWOOD, MS 38930-0389
(662) 392-8163
(601) 944-9780
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16690
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121561
—
MS
05
—
01588099
—
MS
01
—
P00228400
RAILROAD MEDICARE
MS
Enumeration date
10/27/2005
Last updated
07/16/2013
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