Healthcare Provider Details

I. General information

NPI: 1033574579
Provider Name (Legal Business Name): MEDICOMP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 FLOWERS DRIVE
BLAKELY GA
39823-2574
US

IV. Provider business mailing address

2015 HIGHPOINTE DR
BRANDON MS
39042-3169
US

V. Phone/Fax

Practice location:
  • Phone: 229-724-4269
  • Fax: 229-723-2354
Mailing address:
  • Phone: 601-824-8914
  • Fax: 601-824-8828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JOSEPH MCNULTY
Title or Position: CEO
Credential:
Phone: 601-849-6440