Individual
DURHAM NORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-6162
Mailing address
PO BOX 23073, JACKSON, MS 39225-3073
(601) 200-6162
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
29683
MS
Other
Enumeration date
03/28/2016
Last updated
10/06/2022
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