Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | T-4279 | MS |
NPI | 1013594761 |
---|---|
Provider Name | Dr. Melissa Johnson Pippin |
First Address | Madison, MS 39110-6549 |
Second Address | Jackson, MS 39216-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2021 |
Last Update Date | 03/02/2022 |