Healthcare Provider Details

I. General information

NPI: 1124306774
Provider Name (Legal Business Name): MISSISSIPPI STAFF HEALING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 HIGHWAY 51 N
BROOKHAVEN MS
39601-2350
US

IV. Provider business mailing address

760 SIDNEY TRL SE
BOGUE CHITTO MS
39629-9705
US

V. Phone/Fax

Practice location:
  • Phone: 601-835-9444
  • Fax: 601-833-5210
Mailing address:
  • Phone: 601-835-6749
  • Fax: 601-833-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10780
License Number StateMS

VIII. Authorized Official

Name: DR. STEPHEN J MILLS
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 601-835-6749