Organization
MADISON MEDICAL DERMATOLOGY LLC
Active
Organization
MADISON MEDICAL DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAM SHATLEY MD (OWNER / MD)
(769) 300-2100
Entity
Organization
Contact information
Practice address
1607 DOCTOR'S DRIVE, MADISON, MS 39110
(769) 300-2100
(601) 944-9780
Mailing address
1607 DOCTOR'S DRIVE, MADISON, MS 39110
(769) 300-2100
(601) 944-9780
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
07/18/2014
Last updated
07/18/2014
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