Provider Demographics
NPI:1609937853
Name:ARMSTRONG, MARY G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:G
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:350 W WOODROW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7681
Mailing Address - Country:US
Mailing Address - Phone:601-978-7864
Mailing Address - Fax:601-956-5262
Practice Address - Street 1:350 W WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7681
Practice Address - Country:US
Practice Address - Phone:601-978-7864
Practice Address - Fax:601-956-5262
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS11168207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123684Medicaid
MS00123684Medicaid
MS01000124Medicare ID - Type Unspecified