Individual
AQFA SULTANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 364-5142
(601) 364-5159
Mailing address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 364-5142
(601) 364-5159
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
21234
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07331261
—
MS
05
—
09964
—
LA
Enumeration date
07/25/2007
Last updated
09/23/2020
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