Graves, Marilyn Davidson

Graves, Marilyn Davidson is an sole proprietor health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Graves, Marilyn Davidson can be contacted via phone (601) 815-7554.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Fax: (601) 815-3226
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 05990 Mississippi

Profile Details

NPI number 1316149040
LBN Legal business name Graves, Marilyn Davidson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 4th, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316149040 NPPES
Mississippi MEDICAID 0014881

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