Individual
DR. VIRGIL ISAAC AULTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2747 OLD CANTON RD, JACKSON, MS 39216-4308
(601) 366-6452
(601) 366-6488
Mailing address
2747 OLD CANTON RD, JACKSON, MS 39216-4308
(601) 366-6452
(601) 366-6488
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
06153
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00013576
—
MS
Enumeration date
07/11/2005
Last updated
03/15/2010
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