Healthcare Provider Details

I. General information

NPI: 1073254256
Provider Name (Legal Business Name): BENJAMIN JACOB RUSHING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 HIGHWAY 51 N
BROOKHAVEN MS
39601-2350
US

IV. Provider business mailing address

1762 PINE TREE TRL SW
BROOKHAVEN MS
39601-7002
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-6011
  • Fax:
Mailing address:
  • Phone: 601-455-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number31820
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number31820
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: