Healthcare Provider Details

I. General information

NPI: 1215849948
Provider Name (Legal Business Name): PISGAH COMMUNITY CARE PROVIDERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3946 HIGHWAY 43 NORTH
BRANDON MS
39047
US

IV. Provider business mailing address

160 GOSHEN SPRINGS LN
BRANDON MS
39047-7246
US

V. Phone/Fax

Practice location:
  • Phone: 662-607-3163
  • Fax:
Mailing address:
  • Phone: 662-607-3163
  • Fax: 601-741-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA GRAHAM
Title or Position: MANAGING MEMBER
Credential: NURSE PRACTITIONER
Phone: 601-540-8658