Healthcare Provider Details

I. General information

NPI: 1528754553
Provider Name (Legal Business Name): BENJAMIN T HUBBARD III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MEDICAL CENTER DR STE B
BATESVILLE MS
38606-8629
US

IV. Provider business mailing address

255 MEDICAL CENTER DR STE B
BATESVILLE MS
38606-8629
US

V. Phone/Fax

Practice location:
  • Phone: 662-563-2163
  • Fax:
Mailing address:
  • Phone: 662-563-2163
  • Fax: 662-563-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33823
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: