Ellisville State School
NPI #1568468080 in Ellisville, Mississippi
Provider Information
- NPI Number
- 1568468080
- Entity Type
- Organization
- Organization Name
- Ellisville State School
- Primary Specialty
- Clinic/Center
- Enumeration Date
- Jun 21, 2005
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 1101 HWY 11 S
- City
- Ellisville
- State
- Mississippi
- ZIP Code
- 39437-4444
- Phone
- (601) 477-9384
Authorized Official
- Name
- DR. SUZIE LASSITER
- Title
- DIRECTOR
- Phone
- (601) 477-9384
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center |
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