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NPI Code Detail

MEDICARE: DELTA PHYSICIAN PRACTICES

MEDICARE: DELTA PHYSICIAN PRACTICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician
22084P0800XPsychiatry Physician
3363L00000XNurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225157506
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELTA PHYSICIAN PRACTICES
Provider Business Mailing Address
First Line : PO BOX 23998
Second Line :
City : JACKSON
State : MS
Zip : 39225-3998
Country : US
Telephone Number : 662-725-2749
Fax Number : 662-725-2741
Provider Business Practice Location Address
First Line : 300 S WASHINGTON AVE
Second Line :
City : GREENVILLE
State : MS
Zip : 38701-4719
Country : US
Telephone Number : 662-378-2020
Fax Number :
Authorized Official
Title or Position : CEO
Name : MS. IRIS STACKER
Credential :
Telephone Number : 662-725-2264
Provider Enumeration Date : 03/28/2007
Last Update Date : 11/04/2022

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1497830806 — DELTA HEALTH SYSTEM
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1366592610 — DELTA HEALTH SYSTEM
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1255543492 — GAIL L GRIFFIN
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1689936999 — MRS. KIMBERLY L MARTIN M.ED., LPC, NCC
Practice Location Address:
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Directions to “DELTA PHYSICIAN PRACTICES ” Practice Location

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