Julie P Wyatt
Dermatologist
3000 Old Canton Rd Ste 430
Jackson
, Mississippi 39216
Julie P Wyatt
Dermatologist
3000 Old Canton Rd Ste 430
Jackson
, Mississippi 39216
(601) 815-6613
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About
Features
Specialties
- Dermatologist
Languages spoken
- English
Location
First Address
- Julie P Wyatt
- 3000 Old Canton Rd Ste 430
- Jackson, MS
- Zip : 39216-4225
- Fax : (601) 815-6613
- Phone : (601) 982-5441
Second Address
- Julie P Wyatt
- 3000 Old Canton Rd Ste 430
- Jackson, MS
- Zip : 39216
- Fax : (601) 982-5442
- Phone : (601) 982-5441
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 20645 | MS |
National Provider Identifier
| NPI | 1053532226 |
|---|---|
| Provider Name | Julie P Wyatt |
| First Address | Jackson, MS 39216-4225 |
| Second Address | Jackson, MS 39216 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/05/2007 |
| Last Update Date | 30/08/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 08655862 | (05) | MS |
| P00781089 | RR MEDICARE (01) | |
| P01193355 | RAILROAD MEDICARE PTAN (01) | MS |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.