Provider Demographics
NPI:1215158654
Name:PERRY, ELIZABETH HENDERSON (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HENDERSON
Last Name:PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:118 DEPOT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9394
Mailing Address - Country:US
Mailing Address - Phone:601-291-9550
Mailing Address - Fax:601-605-1950
Practice Address - Street 1:118 DEPOT DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9394
Practice Address - Country:US
Practice Address - Phone:601-605-9599
Practice Address - Fax:601-605-1950
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS107282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry