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General NPI Number Information
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NPI Number | 1245868801
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE SKIN CARE OF MISSISSIPPI, PLLC
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 731 S PEAR ORCHARD RD STE 16
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City | RIDGELAND
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State | MS
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Zip | 39157-4800
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Country | US
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Telephone | 601-672-2044
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Fax |
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Provider Business Mailing Address
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Address Line | 114 COPPERRIDGE DR
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City | BRANDON
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State | MS
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Zip | 39042-3700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. JASMINE CAMPBELL HOLLINGER
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Credential | MD
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Telephone | 769-300-9447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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