Provider Demographics
NPI:1104002898
Name:SANDIFER, VANESSA LACKEY (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:LACKEY
Last Name:SANDIFER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:971 LAKELAND DRIVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-0450
Mailing Address - Country:US
Mailing Address - Phone:601-948-5158
Mailing Address - Fax:601-949-6058
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 450
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-948-5158
Practice Address - Fax:601-326-4265
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2023-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS20965207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism