Individual
MS. MIRANDA STREET SUDDUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1607 DOCTORS DRIVE, MADISON, MS 39110
(601) 927-2146
Mailing address
82 MOSS WOODS DR, MADISON, MS 39110-9161
(601) 927-2146
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00212
MS
Other
Enumeration date
09/18/2014
Last updated
05/07/2015
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