Healthcare Provider Details

I. General information

NPI: 1639819451
Provider Name (Legal Business Name): EMILY SAUCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAKELAND PL
FLOWOOD MS
39232-6678
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 888-815-2005
  • Fax:
Mailing address:
  • Phone: 888-815-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number37335
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: