NPI 1306632344 · live from the CMS NPI Registry
Modupe Harriet Ajisafe, M.D
Family Medicine in Jackson, MS. National Provider Identifier 1306632344, active.
NPI record
| NPI | 1306632344 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | Department Of Family Medicine, 2500 N State St, Jackson, MS 39216 |
| Practice phone | 601-984-5426 |
| Mailing address | 1855 Lakeland Dr Apt 415, Jackson, MS 39216 |
| Enumerated | April 16, 2025 |
| Last updated | November 5, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine primary | 207Q00000X | T5940 (MS) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.