Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3552-10 | MS |
Y | 1223P0221X | Pediatric Dentist | 3552-10 | MS |
NPI | 1053622670 |
---|---|
Provider Name | Joey Kim Sessums |
First Address | Brookhaven, MS 39601-3301 |
Second Address | Brookhaven, MS 39601-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 07/05/2018 |