Provider Demographics
NPI:1033273313
Name:EMERLE, AGNES (MD)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:
Last Name:EMERLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W LAKEVIEW DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-7960
Mailing Address - Country:US
Mailing Address - Phone:601-444-4798
Mailing Address - Fax:601-444-5127
Practice Address - Street 1:2 W LAKEVIEW DR
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-7960
Practice Address - Country:US
Practice Address - Phone:601-444-4798
Practice Address - Fax:601-444-5127
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17887208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126889Medicaid
MS00126889Medicaid