Healthcare Provider Details

I. General information

NPI: 1104977560
Provider Name (Legal Business Name): STEPHEN K OTEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EARL FRYE BLVD SUITE A
AMORY MS
38821-5507
US

IV. Provider business mailing address

900 EARL FRYE BLVD SUITE A
AMORY MS
38821-5507
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-9331
  • Fax: 662-597-6008
Mailing address:
  • Phone: 662-256-9331
  • Fax: 662-597-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number15322
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: