Provider Demographics
NPI:1699937680
Name:SHIPLEY, SONYA ROCHELLE (MD)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:ROCHELLE
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:ROCHELLE
Other - Last Name:CLEMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DEPT OF FAMILY MEDICINE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-4778
Mailing Address - Fax:601-984-5420
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPT OF FAMILY MEDICINE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-4778
Practice Address - Fax:601-984-5420
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20879207Q00000X
TN48525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01402396OtherRR MEDICARE
MS06435092Medicaid
MS328823YJ5DMedicare PIN