Individual
SUSIE B PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2940
(601) 984-2926
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2940
(601) 984-2926
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
23466
MS
208000000X
Pediatrics Physician
T-2592
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01022856
—
MS
05
—
194754
—
AL
Enumeration date
06/29/2012
Last updated
05/09/2017
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