Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | R518921 | MS |
NPI | 1003331893 |
---|---|
Provider Name | Melissa Jean Vinson |
First Address | Fulton, MS 38843-8996 |
Second Address | New Albany, MS 38652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2017 |
Last Update Date | 22/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04558541 | (05) | MS |