Healthcare Provider Details

I. General information

NPI: 1639427776
Provider Name (Legal Business Name): DRA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 JACKS PL
BRANDON MS
39047-4450
US

IV. Provider business mailing address

248 WOODLAND BROOK DR
MADISON MS
39110-7365
US

V. Phone/Fax

Practice location:
  • Phone: 601-503-4432
  • Fax:
Mailing address:
  • Phone: 601-955-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: TONY GINES
Title or Position: OWNER
Credential:
Phone: 601-955-5008