Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 3587-11 | MS |
Y | 213EG0000X | General Practice | 3587-11 | MS |
NPI | 1003100165 |
---|---|
Provider Name | Mrs. Catherine Carter Sledge |
First Address | Jackson, MS 39211-4217 |
Second Address | Jackson, MS 39211-4217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 07/06/2011 |