Provider Demographics
NPI:1942739628
Name:SEVERNS, ANNILIN MASAN (MD)
Entity Type:Individual
Prefix:
First Name:ANNILIN
Middle Name:MASAN
Last Name:SEVERNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNILIN
Other - Middle Name:M
Other - Last Name:SEVERNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:504 CLINTON CENTER DR STE 4300
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5610
Mailing Address - Country:US
Mailing Address - Phone:601-815-2005
Mailing Address - Fax:601-815-0434
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-2005
Practice Address - Fax:601-815-0434
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS32214207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology