MEDICARE: STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1760285936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 11407
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-2130
Country	:	US
Telephone Number	:	601-984-1000
Fax Number	:	601-815-0434

Provider Business Practice Location Address
First Line	:	163 RIVER OAKS DR
Second Line	:
City	:	CANTON
State	:	MS
Zip	:	39046-5313
Country	:	US
Telephone Number	:	601-984-1000
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE CFO - CLINICAL OPERATIONS
Name	:	JEFFREY GRIMSLEY
Credential	:
Telephone Number	:	601-815-6270

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/17/2026

Similar Medicare Providers

1174831218 — CANTON PHYSICAL MEDICARE, LLC
Practice Location Address:

2050 CUMMING HWY , SUITE 100
CANTON, GA
30114-8614

Practice Phone: 770-345-9600
Practice Fax:

1043064660 — DORIAN RENUALD SEYMOUR JR.
Practice Location Address:

4566 AURORA ST NW
CANTON, OH
44708-5313

Practice Phone: 330-208-8957
Practice Fax:

1831926948 — REMIND ME WELLNESS CLINIC
Practice Location Address:

712 E PEACE ST
CANTON, MS
39046-4731

Practice Phone: 601-720-1531
Practice Fax:

1821097858 — MRS. STEPHANIE PERRY JACKSON CFNP
Practice Location Address:

162 FEATHER LN , SUITE E
CANTON, MS
39046-8510

Practice Phone: 601-859-0140
Practice Fax: 601-510-9643

1093701526 — PEYTEN, LTD.
Practice Location Address:

1883 HIGHWAY 43 S , SUITE A
CANTON, MS
39046-8405

Practice Phone: 601-407-1440
Practice Fax: 601-407-1441

1427044593 — PEYTEN, LTD.
Practice Location Address:

265 W PEACE ST
CANTON, MS
39046-4325

Practice Phone: 601-859-1303
Practice Fax: 601-850-3603

Directions to “STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.