Provider Demographics
NPI:1972916633
Name:DUCKWORTH, SAVANNAH (MD)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:DUCKWORTH
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 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5770
Mailing Address - Fax:601-984-5773
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:UMMC DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-984-5770
Practice Address - Fax:601-983-5773
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06633737Medicaid