Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | AT0894 | MS |
NPI | 1134769938 |
---|---|
Provider Name | Micah Mckee |
First Address | Grenada, MS 38901-8647 |
Second Address | Grenada, MS 38901-8647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2020 |
Last Update Date | 09/01/2020 |