Individual
GRANT JERNIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 575-1194
Mailing address
4500 13TH ST, GULFPORT, MS 39501-2515
(318) 348-4255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
28346
MS
208M00000X
Hospitalist Physician
Primary
28346
MS
Other
Enumeration date
03/22/2018
Last updated
08/10/2023
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