Individual
DR. JUSTICE AARON GONDWE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
965 J K AVENT DR, SUITE 106, GRENADA, MS 38901-5045
(662) 227-6450
(662) 227-6452
Mailing address
965 JK AVENT DRIVE, SUITE 106, GRENADA, MS 38901
(662) 227-6450
(662) 227-6452
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
20373
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0491951
—
IA
01
—
25140
BCBS
IA
05
—
3116087
—
IA
Enumeration date
07/22/2006
Last updated
04/21/2025
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