Most Relevant Information
Provider Data
| NPI Number: | 1003375858 |
| Provider Name: | MARLEE WADSWORTH MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/19/2019 |
| Last Updated: | 03/19/2019 |
Provider Practice Location
2500 N STATE ST
JACKSON
MS
392164500
Practice Location Phone/Fax
| Phone: | 6018150600 |
| Fax: | 6018150985 |
Provider Mailing Location
2500 N STATE ST
JACKSON
MS
392164500
Provider Mailing Phone/Fax
| Phone: | 6018150600 |
| Fax: |