Healthcare Provider Details

I. General information

NPI: 1205875143
Provider Name (Legal Business Name): DR. MESERET TEFERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 W GOVERNMENT ST
BRANDON MS
39042-2408
US

IV. Provider business mailing address

PO BOX 24116
JACKSON MS
39225-4116
US

V. Phone/Fax

Practice location:
  • Phone: 601-825-7280
  • Fax: 601-825-8130
Mailing address:
  • Phone: 601-362-5321
  • Fax: 601-364-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19108
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: