Healthcare Provider Details

I. General information

NPI: 1003518663
Provider Name (Legal Business Name): SOLSTICE DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 LAKELAND DR STE 200
JACKSON MS
39216-4843
US

IV. Provider business mailing address

1675 LAKELAND DR STE 200
JACKSON MS
39216-4843
US

V. Phone/Fax

Practice location:
  • Phone: 769-768-7546
  • Fax:
Mailing address:
  • Phone: 769-768-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY EMERSON
Title or Position: OWNER
Credential: MD
Phone: 601-589-1810