Individual
DR. HURSIE J DAVIS-SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1814 HOSPITAL DR, JACKSON, MS 39204-3410
(601) 373-2940
(601) 373-2720
Mailing address
PO BOX 55869, JACKSON, MS 39296-5869
(601) 373-2940
(601) 373-2720
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13888
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112110
—
MS
01
—
080153132
RR MEDICARE HFCA 31
MS
05
—
08236531
—
MS
01
—
CG6643
RR MEDICARE HFCA 33
MS
Enumeration date
06/29/2007
Last updated
07/11/2013
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