Healthcare Provider Details

I. General information

NPI: 1871597385
Provider Name (Legal Business Name): DONALD W RATLIFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 THIRD ST
BELMONT MS
38827-0190
US

IV. Provider business mailing address

PO BOX 190
BELMONT MS
38827-0190
US

V. Phone/Fax

Practice location:
  • Phone: 662-454-3401
  • Fax: 662-454-3401
Mailing address:
  • Phone: 662-454-3401
  • Fax: 662-454-7278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7354
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8253
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: